Chronic Pain and Substance Abuse: Types, Causes, and Treatment

Chronic Pain:

• Common types of CP: acute pain, arthritis, low back pain, neck pain, musculoskeletal disorder (4th greatest impact on world population)
• Common causes of pain: Nociceptive (normally functions Nervous system), neuropathic (abnormally function nervous system)

Risk factors with CP:

• aging, genetic predisposition (migraine), chronic disease (cancer), injury (low back pain), surgery (nerve damage), socioeconomic factors (education, poverty, health insurance coverage)
• migraines most common in females, back pain in males

Functional limitations:

• squeezing, migraine headaches, disability headache, impact activity tolerance

Workplace implications:

• 26% indicate pain as issue in employment, 19% had lost jobs, 16% change job tasks, 13% changed jobs, 13% lost at least 16 days from work

Treatment:

• self-management, primary care, specialty care, pain center

Complications with treatment:

• lack of health coverage, education of primary care, liver issues, cox-inhibitors, impact blood pressure, kidney disease, opioids addictive, cognitive difficulties, overdose, constipation, addiction

Barriers:

• education of clinicians, time constraints, unrealistic expectation from patient and providers, lack of health coverage, incentive for procedures in many existing health plans, racial disparities in access to care

Medications:

• non-steroidal anti-inflammatory drugs, adjuvant medications, topical medications, opioids

Substance Abuse

• Prevalence: 10 to 15% pop of world have SA problem, 15 to 30% of people with disabilities SA
• Physiological mechanisms: want to repeat experience, poor decisions, association circumstance release the stimulus, feel good
• Associations between disability and SA: 15 to 30% of people with disabilities, 40 to 75% of all VR consumers diagnosed with MHI have substance abuse
• Major class of common SA: opioids, stimulant, major ones: cocaine, depressants, alcohol
• Treatment and recovery: self-recovery, AA, get exercise to release dopamine and serotonin, anti-depressant, antabuse, carpal, suboxone-block, naltrexone, methadone, naloxone
• Legal implications: It is a disability; addicts or alcoholics are covered through ADA; know they have disability from medical records, send to doctor, treatment records, verified by sponsor; active user still covered; not covered if they go to work high or drunk, ADA, Rehab Act
• Physiological consequences of SA: alcohol-cirrhosis of the liver, nerve damage, cancer of the mouth and throat, cognitive impairment, HBP and heart disease, losing game
• DOPEAMINE&SEROTONIN: chemical messengers that relay nerve messages through the brain. They bind to specialized receptors on neighboring nerve cells causing them to fire an electrical impulse
• Process causes: Desire to repeat the experience; they don't only want the experience, they associate the circumstances with pleasure. Association of people with pleasure: drug, circumstance, people