I Don’t Recall Signing on for This
When I was young girl, allowed to spend time in the world of make-believe with nowhere else to go in my reveries but the land of tomorrow, I pretended to be a princess. I dreamed about becoming a bareback rider or an actress performing on a gilded stage, taking my bows while an adoring audience gently pelted me with roses. I don’t remember ever thinking, “Maybe I’ll be a single mother, a person with mental illness, a recovering addict, and yes, I want to live with chronic pain.” Funny how life has a way of pummeling you with lemons—and what comes floating down like a feather just as you raise your fist to shake it at the heavens? A recipe for lemonade.
I get to work daily on things I am passionate about: wellness and recovery self-management; shared decision making in behavioral health; opioid addiction prevention and recovery; and lately, maintaining quality of life while living with chronic pain. A physician I admire very much once said, “It is usually a mistake in medicine to attribute any condition to a single cause.” That resonated deeply with my personal experience of chronic pain. Most days, chronic pain is like “white noise.” It’s always in the background, but I’ve grown used to it, and sometimes the pain is barely noticeable.
Then there are those difficult days when I have more than one type of pain. Days when lack of sleep, the onset of a headache, high levels of stress, or just feeling kind of down starts to push me over my threshold. Those are the days the white noise of chronic pain amplifies to the point of drowning out everything else. Suddenly, it has taken center stage and the rest of my life feels like it’s hardly noticeable in background. But for me, just as it generally takes a combination of factors to trigger this situation, I have to marshal a combined response that draws from every dimension of wellness to remedy it. Only one of them is physical. If I focus too much attention on relieving the pain, I usually end up chasing my tail.
Any Color You Want as Long as It’s Gray
There are many diverse cognitive, kinesthetic, mindfulness, topical, safe pharmaceutical, natural, herbal, dietary, and traditional approaches that can work for people with chronic pain. There are at least three types of stimulation devices; crystals; touch and manipulation of all kinds; equine, canine, feline and expressive therapies; and curatives from cultures across the globe. No single approach works for everyone. Unfortunately, the mistakes we have made in recent years with treating chronic pain have become disturbingly clear in hindsight. Over-reliance on opioid prescribing has contributed to disastrous unintended consequences. The four-fold increase in prescribing of opioid analgesics over the last 15 years is directly related to an epidemic of opioid addiction and overdose fatality rates beyond anything ever seen before.
Nationally, overdose deaths involving commonly prescribed opioid medications continue to exceed heroin fatalities.(1) A recent study of individuals participating in opioid treatment programs found that more than one third reported that their reason for seeking treatment was related to opioid use for physical pain.(2) Today, an individual who identifies as being addicted to opioids is far more likely to have started out using a prescribed pain medication than an illicit drug. This is a departure from decades of drug use trends in the U.S.(3) Obviously, opioids don’t work for everybody. New research suggests they rarely provide a long-term solution for anybody. As far as a standard one-size-fits-all approach to chronic pain, the risk/benefit profile of placebo wins out over opioids, hands down.
On a Scale of 1-10, How Much Better Do You Feel?
I became interested in WRAP for chronic pain almost 2 years ago. Since that time, many markers I’ve encountered on my journey into the science of chronic pain keep pointing in that direction. Chronic pain is a reality for so many people, including people in recovery from substance abuse and those with mental health issues. The more options people are aware of, the faster they can home in on the things that work for them. WRAP is a powerful tool for accumulating information and options that can improve quality of life.
In 2016, the Centers for Disease Control and Prevention (CDC) released updated guidelines for prescribing opioids for chronic pain based on current research that demonstrates limited benefits for long-term pain management. The new guidelines emphasize the need for providers to fully advise patients about the risks involved and the alternative approaches that are available to them. These practices ensure patients are equipped to make informed decisions together with their health care providers. WRAP is one of the ways people can ensure this takes place.
Chronic pain isn’t a bigger, longer, older version of acute pain. On the contrary, very different mechanisms contribute to acute pain, which is part of the body’s signaling system for alerting us when there’s a hardware problem (infection, a broken bone, potential tissue damage, etc.). Chronic pain, on the other hand, is a problem with the nervous system “software.” It is pain that doesn’t serve the function it was created for—something to which the processing areas in the brain have become hyper-sensitized.(4) Pain that has its origins in the brain is no less real than pain that comes from responses centered in the body. However, the solutions that focus on relieving physical pain do nothing to address the conditions in the brain that sustain chronic pain. By definition, we accomplish that through approaches that target the body–mind connection, holistic approaches to mental, physical and emotional wellness that preserve and protect quality of life from the threat chronic pain can represent. Beyond WRAP’s potential to ensure a variety of accessible, effective alternative approaches to pain, beyond its use as springboard to safeguarding patient autonomy, the biggest advantage WRAP can offer is its affinity for re-focusing us on wellness, away from the “problem”—or in this case the pain.
The next article in this series will explore the specific application of various WRAP components to living with chronic pain.
If you’re living with chronic pain or know someone who is, be sure to check out all four parts of this series on WRAP for chronic pain:
- Part 1—WRAP for Chronic Pain: Good for What Ails You
- Part 2—WRAP for Chronic Pain: Negotiating Your Quality of Life
- Part 3—WRAP for Chronic Pain: Rethinking, Reclaiming, and Replacing
- Part 4—WRAP for Chronic Pain: Sometimes Suffering is Optional
 CDC – Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015 MMWR December 30, 2016 / 65(50-51);1445–1452.  Addiction Treatment Forum (2011). Study reports changing demographics of OTP patients. AT Forum Volume 21, #1– Winter 2011. Retrieved from http://www.atforum.com/newsletters/2011winter.php#recoveryconfirms.  American Society of Addiction Medicine, 2013. Advancing Access to Addiction Medications: Implications for Opioid Treatment: https://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final.  Dr. Mel Pohl, Chief Medical Officer, Las Vegas Recovery Center, 2017 Podcast, Chronic Pain/Alternatives to Pain Management.
Niki A. Miller, MS, CPS, is a Senior Research Associate at Advocates for Human Potential, Inc.