In 2009 a study* was published that revealed a correlation between self-injurious behavior and the neuro-receptor activities that are associated with pain and pleasure. For some years, I have been intrigued with the interplay of physiological pain, psychic pain and human behaviors or choices in response to the natural & human realities of pain and pleasure. A “cluster” of pain forms with some individuals that confounds both the patient and the clinician (prescriber or counselor) to a much sooner point of impasse ( and surrender) rather than illumination (and supercedence.) It is in this missive that I intend to articulate suggestions about how opioid dependence manifests, and, how it may be remedied.
To begin, I offer simple perspective on the two domains of pain I mention above. A working definition for physiological pain is any discomfort, of varying type or intensity, related to injury, illness or aging that may be incidental or chronic. Many disorders of the central nervous system (CNS) such as Multiple Sclerosis or Meniere’s Disease are chronic pain and discomfort causes. Back injury and core skeletal issues (ie. pelvic fracture or internal orthopedic prostheses) compromise and constrict patients with physical pain and discomfort. Any and all of the possible physio-pathologies that can fuel a dependence on some analgesic or opioid substance. Fibromyalgia ranks very high in this scheme of pervasive or chronic physical pain by my estimation. All of them are subject to exacerbation by psychic pain.
Many or most behaviorists or practitioners of the mental health variety recognize two domains of human experience, including pain and pleasure, within the scopes of mind and spirit. Whether a holistic – mind, body & spirit – construct is applied, or moreover one of theological or dogmatic nature, a spiritual realm of experience translates much in the same manner, yet distinctly from, the psychological. For example, many over the course of my career have noted a difference between severe depression and being “broken-spirited.” Countless examples of this matter will be cited in a subsequent article or chapter for illumination on this notion. As with physiological pains, psychic pains (or pain) are subject to exacerbation by their physical counterpart.
The quantification of physical and psychic pain is a necessary ingredient and precursor to relief and remedy. At the same time, it is a very difficult task to achieve. Briefly stated, the challenge is to form a mindfulness that can quantify or calibrate displeasure or pain intelligently. The frequently used pain scales that medical care employs are rarely if ever used by physical medicine as well as in the psychological or talk therapy disciplines. Patients readily define their worst-ever physical pain as the top of a one-to-ten scale, and it is my experience that the same application can be done for psychic pain. Few patients in my practice have been unable, when asked, to name a time and scenario that presented their worst-ever psychic pain. They are, in fact, capable to immediately name their worst experience of psychic pain. The mindfulness that recognizes both distinct realities is rare, and only achieved through rigorous and honest reflection.
Rigorous honesty is much more readily achieved with an interdisciplinary platform of care. A medically sensitive behaviorist can help a patient optimize their treatment and recovery if they are able to establish and maintain a collaboration with a mutually sensitive prescriber. The collaboration need not be one of frequent communication and comparison of clinical impressions as much as one of mutual consent, care planning and care delivery.
*Opiate mechanisms in self-injury, Sandman & Hetrick 2009. University of California Press (Irvine.)