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Woe is Me! A Day in the Life of a Tapering Opioid User

Sometimes things have to get worse before they get better. As much as we wish all injured workers who taper off long-term opioid therapy could feel terrific throughout the process, that’s just not the case.

Most opioid users experience at least some type of withdrawal symptoms, which can be effectively managed if an expert monitors and oversees the process. But many injured workers also experience increased pain during the initial tapering progression. There are a couple of reasons why this happens, and it’s important to understand and apply the appropriate strategies to help them get through this phase and realize there truly is light at the end of the tunnel.

The Physiology Sufferer

Chronic pain may never disappear entirely, but that certainly doesn’t mean it has to ruin a person’s life. Unfortunately, opioids can mask the pain, meaning that when someone is weaning off of them, the pain flares up again.

Using opioids in the short term to deal with intense pain may be appropriate for some injured workers, such as those immediately out of surgery or in instances where there is a severe, acute injury. Over the long term, however, they cause much more harm than good, as the injured worker becomes increasingly more reluctant to the idea of tapering off them.

What these patients really need is to a) get off the opioids and b) learn non-pharmacological ways to cope with their pain, so they can function again.

The Conditioned Casualty

The other reason some people experience worse pain when they are coming off opioids is that their minds and bodies have convinced them that they need the medications to feel OK.

Think Pavlov’s Dog: a Russian physiologist discovered that dogs under his care would salivate when they thought they were about to be fed — even if there was no food present. He rang a bell when he was ready to feed them. After a short time, he found the dogs would salivate at the sound of the bell itself — a conditioned response.

Humans can also develop conditioned responses. In the case of chronic pain and opioids, the drug produces a ‘high’ which masks the pain. The drug does not eliminate the pain, but the ‘good feeling’ associated with the drug covers it. Over time, the body becomes conditioned to needing the drug when it feels pain, even when the pain generator has resolved. The brain tells the person he must have another opioid to reduce the pain.

When the injured worker tapers off the drug, the euphoric feeling ends. But the mind continues to tell the body it is in pain and needs the opioid. When the body doesn’t receive it, the pain experience seems to worsen.

What to Do

The same problem exists in both cases: eliminating the substance that masked the pain makes the injured worker feel much more pain than when he was taking opioids. To address this, the injured worker needs to understand why he is feeling more pain, and he needs to know that he can feel better.

In the case of the ‘conditioned victim,’ his brain needs to be retrained so it does not automatically feel an intense need for opioids at the first sign of pain. The ‘physiology sufferer’ must understand his pain will never be fully gone, but that various techniques can allow him to manage it enough so he can function.

Practicing CBT

Evidence-based medicine points to cognitive behavioral therapy (CBT) as one of the main tactics to help these injured workers. The intent of CBT is not to eliminate the pain, but to work on the mind-body connection, teaching the person what chronic pain is and the different ways to think and act so he can cope with it.

Once the injured worker learns and practices various CBT techniques, he can resume a productive life without the need for opioids. This process does not take long, but to be successful, it takes understanding and a dedicated commitment.

About half of the injured workers that we help taper off long-term opioid use fall into one of the two categories mentioned above. Using the skills of CBT, the majority are able to get past these symptoms and live opioid-free. 

Conclusion

When opioid users are tapering their drug dependency, it’s important to understand how they will react and to apply appropriate strategies to counteract their reactions to ensure that their situation improves. Cognitive behavioral therapy (CBT) can effectively achieve this, as it works on the mind-body connection to teach patients different ways to address pain so they can cope with it.

IMCS – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. IMCS makes intervention efficient with a national network of 1,000+ psychologists and psychiatrists in all 50 states.