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The Relationship Between Pain, Drug Use and Opioid Dependence

Waismann Method Podcast Pain and Dependence

Episode 11: Pain, Drug Use, and Dependence.

How Do We Deal With Pain in a Healthy Way? How Can We Deal With It Once We Get Free From Opioid Dependence?

The relationship between pain and drug use has always been a close one. Physical, emotional, and psychological suffering both trigger and fuel the dynamic of dependence.

In this episode, Clare Waismann, RAS/SUDCC, and David Livingston, LMFT, answer questions about the role that pain plays in opioid dependence, the psychological elements of how it affects us, and healthy ways to cope pain.

Dwight Hurst, CMHC: Ouch. You know that noise, ouch, ouch. Somebody once told me, Ooch, but I’ve never heard anyone say it. Those are noises of pain, and pain is what we’re talking about today. It’s a super fun subject. I think you’ll find that pain is directly connected with addiction.

Dwight Hurst, CMHC: Many times were even introduced to opioid dependence because of pain because of medical procedures that can lead to misuse, leading to misery. Pain is often associated with misery. How do we deal with pain in a healthy way? How can we deal with it once we get free from opioid dependence, which can also mask it while causing pain? And we take away that mask, and we have to find other ways to deal with it. I want to talk with Clare and David today, and we’ll see if we can figure out some ways to deal with that and deal with our pain.

Dwight Hurst, CMHC: Well, I threw together some questions about the pain I thought might be interesting ways to start. I think one of the obvious ones when you talk about opiates and opioid dependence is painkillers. Right. That’s got to be up on our list of things to talk about as where people oftentimes get introduced to dependence. What are some of the feelings that the two of you get being very deep inside this recovery and detox process and industry? What do you see with the effects of painkiller addiction and painkiller overuse? What are your thoughts you’ve gathered over the years?

Clare Waismann, CAODC: You know, the people that I talk to in the last two decades, I have concluded that you know, some people ask, why do some people get addicted to painkillers and others don’t? I think there are. There is a situation of timing and mental health factors that exists, so it is not one or the other, but all of them; I think all of us human beings have moments in our lives of the weakness of exhaustion. And so when the injury, the injury occurs, and that patient is prescribed opioids, I think it makes it very different. The results will be very different. What time in that person’s life, you know, they had pain relief because pain is not limited, you know, for your physical or emotional being is actually a mind and body experience. So when you take a painkiller, your body in your mind is affected. So it’s unrealistic for us to think that we can, you know. See or treat the mind and the body separately when we’re dealing with things.

Dwight Hurst, CMHC: Yeah, I noticed that when people have chronic conditions that they take opiates for, they often display some form of restricted emotion. And sometimes they’re even aware of it. Even when they’re taking them as they are supposed to, they still will notice that it’s harder for me to express myself or there’s some emotional difference in the way they function and for them or their spouse or partner, their kids, that can be difficult to deal with.

Clare Waismann, CAODC: Yeah, I think, more than then, a different emotion. There is a lack of emotion; there is indifference; there is, you know, somebody that is physically present but not emotionally present as the ones around them would expect.

David Livingston, LMFT: Right, right, I think that’s all true, but, you know, one of the things that I’ve I’ve had people report to me just over and over again is that at least initially, when they take opiates, they feel an increase in energy, a cessation of pain. Their nervous systems are relaxed; it decreases anxiety, decreases any feelings of depression if there are, and feels better overall.

David Livingston, LMFT: And so what are you what I think happens, which is part of the reason it’s become so addictive, among many other factors. Right. So I’m just talking more on a chemical basis. If you think about all of those factors, an increase in energy, a cessation of pain, a decrease in anxiety or depression feelings, it just creates a profound sense of well-being. And evolutionarily, anything that hits all those markers probably registered in the deep brain, not just in the not like, oh, “this feels good touching,” but I mean, it hit all these markers simultaneously. Once that happens, it’s almost as if there’s a process that takes hold deeply, and they never seem to forget about it. In fact, despite everything you guys are saying is right, because as the evolution of the process takes place, that that there’s a decrease in that benefit, it gets worse. Then eventually, it’s just sort of sustaining and staying out of withdrawal. And then it goes the other direction where it just regulates the nervous system. You get inside, and you get upset and sleep. It causes pain and worse. So but people don’t remember and register that piece of it the way they do that very first part of it, which is such an interesting thing that the painful part of it, which can go on for years for some people, for nothing to register like that, that initial experience.

Dwight Hurst, CMHC: Yeah, that’s what they call. I know in heroin use, they often call it chasing the Dragon. Right. Trying to recapture that first experience. I have had that. I had the experience. I hadn’t ever taken any opioid-based medication for really my whole life until I had a dental procedure several years ago that impacted wisdom teeth that should have been taken out when I was 18. But whatever, that’s a longer story for another day. And they prescribed me these painkillers. And I’d always heard everybody, not a lot of people in my life, say, “Oh, I hate taking painkillers. They make me feel sick. I feel I feel out of it. They’re terrible.” I’ll tell you, though, I didn’t hate taking them at all. I found that I reacted similarly to what you’re saying, even just taking the prescribed amount. And so that was a clue to me.

Dwight Hurst, CMHC: I guess I should be a little careful, and maybe I’m one of those that’s like, where’s this been all my life? And so I think there are those factors. And if I’m a person who takes it, doesn’t like it, and doesn’t embrace or feel that rush of relief, it’s harder for me to have empathy for somebody who does.

Clare Waismann, CAODC: But I think how people feel things, especially, you know, the perception of the pain, the narrative that they talk about when they experience the pain, is a very different person to person. And I think David is absolutely correct about how the memory is so filtered.

Dwight Hurst, CMHC: It’s kind of romanticized in a way too.

David Livingston, LMFT: Yes.

Dwight Hurst, CMHC: Well, I guess if we’re talking about pain, we’re really talking about relief. And when that’s delivered, that by itself becomes pretty psychologically addictive. I would think about the process…

Clare Waismann, CAODC: I think I think is psychologically I think getting back to, you know, the chemistry of the brain, I think, again, it’s truly a country, you know, all-around experience. And it’s so important that people understand that you can’t, you know, the old one and forget the other. You know, it’s the patients we see that have been taking opioids for such a long time, how they experience not just physical pain, but emotional pain is so different. How not just how the experience but their perception, what pain should be, and how should I mean, I know myself since I turned 50, just, you know, if I sit for a long term or wake up. Getting up and going. It’s a completely different experience than I had five years ago. We have a lot of these patients that are on opioid painkillers. They know for 10 years, 20 years.

Clare Waismann, CAODC: So their idea of what it should be, it’s so unrealistic that it’s you know, it’s what I’m saying to you is what we need to work with them physically to put the dependence behind them. But I think emotionally; there’s so much work just to bring them to the right perception of what to expect for anybody from life, from their emotions. What David was saying, the other podcast about feeling good enough.

Dwight Hurst, CMHC: That’s a complicated narrative to change over time. You mentioned just the changes that come with age where we have to change that internal dialog about pain with youth. We can kind of get away with believing that pain is just to be avoided. Right. As a very little kid is like, ouch, OK, avoid pain. Mostly I can. And for a long time, many us, not everybody, but many people can for a time. And that narrative becomes, I hurt, get better, I hurt, get better. Better means no pain or low pain. Right, right. They have to change that because of surgery or age, or disability or to alter that narrative.

David Livingston, LMFT: I know a lot of what I do in talking with patients afterward has really helped them to sort of recalibrating what is sort of existential suffering this compared to, you know, for lack of a better word, to neurotic suffering, meaning, you know, what is the suffering that we have to accept as part of our lives? And, you know, and then what do we do about it? And the problem with opioids is they become sort of everything that revolves around it. And then you have to begin to pull apart again. What would need to need to be met individually to feel as well as you can? Sometimes people say, you know, I still don’t feel good after a while or whatever else you. Well, how much did you sleep so well? I slept for one hour. I’m like, well, I’m not going to feel good if, you know, I’d be bumping into walls if I slept in one hour. And so then they get to sleep, and they’re like, oh yeah, you’re right. I feel good now. I feel fine now. I’m like, OK. But literally, it doesn’t even register that. When I say it, they can recognize it, but it doesn’t really register that. That’s actually. And then there are other causes too. Right. And sleep a significant one that, you know, we all need to feel to function. OK, but there are many, many others too that stop being recognized. And so part of the process back to yourself and back to help is just slowly determining what all those needs are and then figuring out creative ways and the best ways to meet them to reestablish a sense of well-being and also a feeling that you can affect how you feel again so that it’s not just predicated on this one pill you were taking for a long time that that type of thing.

Dwight Hurst, CMHC: Yeah, it’s I; I read a tweet just the other day where someone said, you know, it’s almost embarrassing after being an adult for as long as I have. How many times I feel terrible for half a day until I remember to drink a couple of water glasses and feel better, like this interaction with my own health and well-being in a way that’s. Well, and it’s not as dramatic. Right. The intake of drugs can provide an almost heightened or supernatural ability to interact with how I feel, although it backfires over time.

David Livingston, LMFT: Right. And distorts it all along the way.

Clare Waismann, CAODC: People want it now. People don’t want to wait. People don’t want to feel any discomfort. Everything has become so immediate in your life; you know what you want. And information, you find it in a second. You want to call somebody, you call them immediately. There are no more delays. So our patience, our ability to handle discomfort have become really, really small. A while before, we used to take a Tylenol or aspirin and wait for that thing to go away. Now we want it to be gone, and we want it to be gone now. And I think that’s where pharmaceutical companies make their profit, offering an immediate response to their distress.

Clare Waismann, CAODC: The issue is there is no long-term cost. What this lack of ability to feel any discomfort is going to lead into…

Dwight Hurst, CMHC:  Unrealistic pain management expectations are essentially a setup to fall into dependence and overuse.

Clare Waismann, CAODC: I would say so. For a very long time now, more than ever, you know, pain management doctors are being screened and regulated, and so are the prescription opioids. What if, somehow, it is not fair for those who have been prescribed the last 20 years? They left these people with no solutions, desperate out there.

Dwight Hurst, CMHC: It’s difficult when you get a situation where, like you say, if I’ve been taking something for decades and then all of a sudden it’s like, let’s transition you. I mean, you know…

Clare Waismann, CAODC: Oh, it is worse than the transition. These people were told it’s over, or you’re not getting prescriptions anymore, or I will give you a prescription for another 30 days. And then what? Now it’s not that they are not feeling pain. I mean, there is the phenomenon that is. I think it is amazing to me that hyperalgesia is not is something that nobody speaks about. There are so many people suffering from this condition is a condition caused by long-term opioid intake. I’m saying. But it is ignored because it’s not profitable to understand the condition. Once you understand the condition, then you have ways to prevent from getting this condition.

Dwight Hurst, CMHC: Now, I’m often surprised how few people know about the risks of opioid-induced analgesia when they’re first prescribed painkillers and that no one’s ever talked to them about it, correct?

Clare Waismann, CAODC: Correct.

Dwight Hurst, CMHC: I was a counselor for several years before I heard that concept. And I was like, why the hell hasn’t anybody told me about this before?

Clare Waismann, CAODC: Right. So it’s pretty amazing. But sadly enough, it is. It’s a reality. And most patients that did start taking opioids when they know when it was prescribed mentally for everybody, for every possible reason, were not told about it and when the consequences happened. Nobody stepped up and gave them solutions, you know, for those issues, and we still are doing the same thing; by the way, it’s not like we stopped doing it. It would just change the name of the opioids that people are being prescribed.

Dwight Hurst, CMHC: Well, you know, you look back and the evolution of drugs as they move through being invented and then prescribed and used, you can track heroin very similar to how we have, you know, opioids in a way or just synthetic versions of the same thing. And heroin was a miracle drug when it was invented. I’m doing air quotes that you can’t see. It went through the same sort of evolution of misuse and then getting to the street drug level.

Clare Waismann, CAODC: That’s correct.

Dwight Hurst, CMHC: That’s a question I would ask in your work through Waismann Method in your clinic. Do you see people come in who have made that sort of opioid medication to heroin crossover? I know that’s fairly common when they don’t have prescriptions.

Clare Waismann, CAODC: Yeah, we see that, sadly enough, more often than not, can we see that by people that you would never think possible and they never thought possible? But again, you know that there are very few options when they come to such desperation of what to do. But I think more than heroin; now it is fentanyl; you can find fentanyl everywhere.

David Livingston, LMFT: But they don’t know what else to do, and they are making decisions that they never imagined they would and head down roads that are dangerous and put a lot of their lives at risk and really don’t want to. But I don’t see a better alternative.

Dwight Hurst, CMHC: I remember hearing a story from is from an individual who, very much just like what we’re talking about, would have never thought of themselves as someone who would be buying drugs on the street, but talking about buying essentially black tar heroin, not to get too specific or to trigger anybody out there, but learning and learning pretty quickly that it was actually a hunk of literal tar. It was fake, right. That the person had sold them and sitting in the car knowing that they were starting to go through the pains of withdrawal, knowing that if they went back and said they use only fake drugs, they’re going to get stabbed or something in this park. And just that realization, not only the pain physically, but this kind of emotional feeling and realization of I never thought I’d be sitting here, you know, skipping work broad daylight, trying to buy drugs, literally crying because of the pain of knowing that this is not what I need, what I need. That’s a lot of emotional pain.

Clare Waismann, CAODC: It’s some fear that you know because there are so many solutions, there are so many available treatments, there are so many ways of helping people, you know, but these issues behind and it’s just not accessible to them.

Dwight Hurst, CMHC: Yeah, and that’s, so that’s a good kind of pivot for us to get into some of the solutions or the strategies maybe that are little, you know, a little on the hopeful side. One of the things that I have been impressed with when we have these conversations, we always get into a pretty dark place. But I have been impressed by how much we’re able to find hope as well. So, you know, we will persevere here. One of the things that stands out to me is that appropriate pain management. First of all, there are internal expectations and must be essential following detox and beginning treatment to find that realistic and helpful pain management professional. Right?

Clare Waismann, CAODC: Right. Well, they know. I think I think at one point they didn’t, but I think at this point they know, and they know what’s available. Opiates are a drug that should be the patient’s mental health should be considered when prescribed a drug to treat a symptom. It’s a hazardous way to practice. When you prescribe a drug to a patient based on not just their health needs, but based on their livelihood, I think the risks are less, and the adverse side effects will be less, so the question is, is this person going to leave my office and drive if this person has to drive their kids home? Does this person have depression that was never treated? So all those things, I think, are factors that need to be evaluated and considered before any drug, not just opiates, any drug is prescribed. But that’s not what we do. Doctors have less time to work with the patient, and they are there to minimize symptoms. And we’re paying a very high price for that.

Dwight Hurst, CMHC: We talk about shifting expectations about pain. And there’s a, you know, therapeutic acceptance. I think I guess that needs to happen, right, for people to do that. Do you? Maybe my acceptable levels of pain have changed to keep me sober and safe. And I do not see zero on a zero to 10 for pain, maybe anymore. How do people accept that kind of things help with that?

David Livingston, LMFT: I mean, I think there are actually things that can help us know that that’s one of the things they teach, and a lot of places is meditation. You know what pain is in the body; what physical pain is specifically is a type of intense feeling of sensations. Right. And so the more you, the more that you can feel around with the sensations, the more you’ll suffer, the less you can feel around them, the less you’ll suffer. So even if the sensations don’t change, your brain’s ability to relax around the intensity of whatever is going on causes less suffering, so they teach that technique through meditation and mindfulness, and other things.

David Livingston, LMFT: It’s a valid process and actually helps people even when the pain can’t be changed or that the intensity of the sensations, which is what pain is, can’t be altered. You can see your relationship with it can alter how much you suffer from it. And that’s a real pain. And I think people and people I talked to who have chronic pain issues, I really push them to explore that because part of what happens that causes people to overuse medications and stuff, they begin to feel really helpless. They don’t have a way to relate or feel like they can affect what’s going on. So that combination can create a real sense of overwhelm, you know, so the ability to understand. Right. Just this equation basically, you know, pain times, resistance equals suffering. So the less you resist it. If you pull a muscle and get into a Jacuzzi, the Jacuzzi heat relaxes and relaxes the muscles. And so even though these injuries and heal, he’ll suffer while you’re in the heat just because there’s less to heal. So the same is true with the brain. So I think we have to help people understand multiple ways to deal with pain. I mean, especially physical pain. And that that’s one of the better ones. I know.

Clare Waismann, CAODC: I think David is saying it is not just positive for physical pain. Still, I think some of these therapies are incredibly important to minimize emotional pain. This, you know, stress, anxiety that all the above teaches you how to respond to uncomfortable feelings, regardless of whether those are emotional or physical or show as emotional or physical, not necessarily one or the other. So I think people undermine the impact of what these therapies can bring because that’s one hundred percent.

David Livingston, LMFT: Then, to what you said before. It also teaches patience – that we have to realize we can wait and be with ourselves. And when you can see with yourself, when you can really be with yourself and begin to feel that you know, you do not have to be so reactive to anything and crosses over like you’re pointing out in many ways.

Clare Waismann, CAODC: Dwight, most of our patients do rapid detoxification. So we can detox them in the hospital. And I think rapid detoxification has gotten a terrible rep around the world because it showed as just a miracle overnight cure how treats in a hospital, you go home tomorrow. You’re great, and you’re going to do fine. And it doesn’t happen.

Clare Waismann, CAODC: One of the reasons it doesn’t happen is because of everything we’re talking about. Once the patient is detoxed, patients have zero endorphins. What that means is that they feel things a lot more intensely. They have zero capacity to withstand discomfort because their brain is used to discomfort, opiate discomfort, opiates, the thought of having discomfort two hours from now – opiates. So you can’t switch that thought from a day to the other. So when we take them, so that’s why we make Domus Retreat, our recovery center where we can help them in that week to know that they will feel better every hour. They sleep; they will feel better.

Clare Waismann, CAODC: Once they start eating, the gut starts working – they feel better physiologically, making them emotionally feel wonderful. You know, we have what we call the “turnaround day.” The “turnaround day” is a patient that is there for a couple of days just dragging and wanting to sleep and not moving much to the day that he wakes up and says, “Wow. I’m feeling pretty good. What that moment is physiological, you know, he starts working, his body’s regulating, and emotionally affected by that regulation. Again, even the patients who move around, we are like David said, Tai Chi and yoga and things like this, the stimulation they know to their circulation helps the immune function, you know, helps the endorphins come in.

Clare Waismann, CAODC: You know, helping with anti-inflammatory foods that give them energy helps minimize that discomfort. We have to stop talking about people due to a certain part of their lives or a part of their being human beings that are tremendously complicated, different, and full of functions that, you know, work together like a clock. When one of them gets disrupted, the rest will suffer the consequences.

Clare Waismann, CAODC: So we got to look at people as human beings, not as chronic pain patients, not as addicts, not as depressed as human beings with a combination of symptoms, of DNA factors, or whatever. But we need to treat the person and stop treating the symptom.

David Livingston, LMFT: Yeah, right. That’s right. You’re not the symptom. The symptom is just information about something that needs to be understood. The idea that you are in chronic pain is just information about one thing that is happening in your life that is at some level, at a certain point in time, and that’s something to be paid attention to. And then that’s got to get sort of put in the proper way of understanding it. And in times you distort, you create suffering. OK, so the purpose of therapy, in general, is to understand and move out of distortions. As things are seeing well and the system is put into a balance, the distortions can be dealt with specifically creatively. You can find better ways to deal with them. And as you move the system towards whatever the good balance is for that human being, whatever really works for them. Well, and discover that we put back together and help somebody sort of really reestablish a sense of their well-being to whatever degree is possible. And like you’re saying. So the symptoms or just information that that’s what they all.

Clare Waismann, CAODC: And disconfirmation, believe it or not, more and more, we have proof that the cognitive therapeutical interventions actually change the brain. The effect that we have in the brain, physical effects that have in the brain, you know, can help with the pain experience, with the distress experienced.

David Livingston, LMFT: I see it all the time when I help someone understand, really understand. So they feel it’s something they’re anxious about or concerned about or something they’re upset about. But we put it to rest. I will ask him, how’s your anxiety right now? They’re saying it’s much, much better. There’s a whole physiological response to that constantly. In fact, that’s my job significantly to understand how there becomes a felt change. And this has been well known and established. It’s fantastic to understand that we can actually just understand and understand and figure things out well that people feel right. It can’t be anecdotal. It has to be really personal, and it has to be felt. And then you get to change.

Dwight Hurst, CMHC: One of the things that’s a recurrent theme on our show is that even though you can go through rapid detoxification, you can’t hurry. Help. Detoxification is one small part of that’s kicking off sobriety and health. And I think that’s the heart of, like, say, Domus Retreat or that first week. Encourage encouragement to continue with good pain management, with good exercise, meditation, possibly therapy, or even family or couples therapy. Any of those can be tools that are there.

David Livingston, LMFT: But you need all the tools that water rapid detox does. It’s excellent that it speeds up and limits suffering because of the pain of getting off an opiate; if you can minimize it and speed it up, why wouldn’t you? Going through it in a prolonged way? I don’t see that there’s any benefit to that suffering. Afterward, you still have to go through the reorganization process to begin to identify needs again. You understand you get the system back into balance, and no matter what method of detoxing or change, that has to happen. But why not? Why not limit the amount of speed up the amount of suffering trying to get you to a different place? You know, that’s really what it does.

Dwight Hurst, CMHC: It’s really changing the thing that you referred to earlier, Clare; when you were talking about we can be in a rush to find an answer, and that’s the kind of thinking that can set us up to get lost in addiction. We definitely don’t want to rush into that thinking when we’re going into treatment.

Clare Waismann, CAODC: No, no. People have to be very careful of A) what to expect from treatment. It’s not going to change your whole life. It’s not going to change your reality. It’s not going to change your future. You were going to do these things, and you’re going to do these things based on what you get from your detoxification, what you get from your therapy, or whatever mental health assistance you will need. So you can’t expect to go in. I don’t care if it’s one day, 30 days, 60 days, 90 days, and have 20 years reversed. It’s not like that. It’s, but it can be really good. It can be really good. But it has your expectations, and your willingness to keep on working for your health has to be sustained. And that is from what you eat, how you exercise, how you sleep, how you deal with stress, how you accept emotional and physical pain. So it’s an attitude. It’s an attitude of health is an attitude… Is it actually more than an attitude of “health” is a responsible attitude to your person and your body.

Dwight Hurst, CMHC: And we’re going to leave it there. As Clare was just saying, not only is it something that you have to do to embrace your treatment, but it’s also something you CAN do. We believe in you just by listening to a show like this shows that you have the interest and what it takes to start whatever path you need to start for yourself or those you love. Anything we can do to help you check us out of the opiates.com for the Waismann Method® Clinic and Rapid Detox program. You can also call anytime at 1-800-423-2482 if you have questions about opioid addiction. As always, the show is hosted by Clare Waismann, founder of the Waismann Method®, and David Livingston, our chief therapist. Our music is the song Medical by Clean Mind Sounds. Waismann Method® podcast is produced by Popped Collar Productions, a company that helps you start up your podcast, especially if you help professionals make sure you’re getting help and need it. Make sure that you’re safe, taking care of yourself. And as always, remember to ask questions. We ask questions, you get answers, and whenever you can, find answers and find hope. Have a good week. We’ll be back again soon with the Waismann Method and more discussions about addiction and recovery. Bye-bye for now!