Comorbidity- Methadone/ Suboxone for Addiction and Chronic Pain
When an addictive type personality is coupled with the stresses of everyday living and chronic pain from whatever cause, the combination results in what is commonly called a comorbid state of affairs. This frequently includes psychological states of anxiety and/or depression. Comorbidity can also be considered as a “dual diagnosis” when disorders have a mental health as well as a physical diagnosis. This is common with all chronic diseases. Addressing all of these issues is most important.
Living with chronic pain naturally would make one depressed. Stress is always present and how we react to it differs. When a problem arises it eventually gets solved. But then it is always replaced with another problem and life goes on. How we handle it is what is important so long as it is done in an acceptable fashion.
Treatment with just one method such as pharmaceuticals is not usually the ideal way to handle your needs. A team approach with medical professionals is frequently the best road to travel. When an addiction doctor recommends a psychiatrist, a psychologist, a psychiatric social worker and/or a counselor to address your mental health needs, it is done with the best intentions for your health. You, with your doctor’s advice can decide together what would be the right choice.
There is also the issue of combining medications or herbals with drugs such as methadone or buprenorphine (suboxone or subutex) that are used to treat opiate addiction. The side effects and/or drug interactions can be life threatening. Having an expert on your team is essential when this situation arises.
Even though suboxone is not FDA indicated for pain, many people who have pain other than from withdrawal symptoms often can find relief when they use buprenorphine and they are fortunate. With more severe pain of a chronic nature, methadone is a stronger agent. The right course of action will be determined by your response and consultation with your doctor and/or team.
Since chronic pain can be relieved markedly by such pharmaceuticals, the underlying cause may also need to be addressed with physical and occupational therapy as well as other modalities including natural ones. Complementary medicine specialists can also be of assistance. Natural energy products such as magnets and infrared have also been known to work well in sensitive patients. Referral to a rehabilitation specialist such as a physiatrist may be considered. These specialists may each have their expertise in different ways of treating pain that will enhance its relief. Examples are acupuncturists, massage therapists, physical therapists, noninvasive injection therapists, interventional therapists, chiropractors, nutritionists, and herbalists. Some chronic pain management groups have anesthesiologists or physiatrists that use more invasive technics such as epidural or facet blocks, insertion of spinal cord stimulators, and injections of tendons and joints which can give dramatic relief.
One conservative physiatry “Alpha Doctor” group that I have successfully referred difficult patients to for almost 50 years is Rosen-Hoffberg Rehabilitation and Pain Management Associates who have a successful conservative and comprehensive approach to pain relief that others have failed to resolve. They provide cognitive and behavioral therapy, counseling, “talk therapy”, physical and occupational therapy in addition to pharmaceutical therapy and chiropractic therapy. They also do trigger point injections which can give immediate relief and are safe.
Another physiatry practice that uses safe and healthy modalities including acupuncture, hypnosis and nutritional therapy, is Mark Young M.D. They all can be extremely helpful for those who are detoxifying or decreasing their opiate use to the lowest amount possible. Sometimes other underlying conditions becomes unmasked during this tapering and require other modalities to assist in relieving discomfort.
There are numerous other chronic pain management consultants with whom I have had success over many years when I was practicing Family Medicine. Inquiries are encouraged and we will do our best to match personalities, wishes, and physical and mental health needs.