Ascension Brighton Center for Recovery

Treatment Philosophies

Addiction Treatment Education

Ascension Brighton Center for Recovery not only treats patients suffering from drug and alcohol addiction, but we also help educate people interested in the addiction recovery field. Addiction hospitals and clinics all over the country need passionate and effective addiction recovery doctors, nurses, and staff; so we place a high value on education.  We have designed special training programs and fellowships for medical students and social work students.  

Managing acute pain in recovering patients

Management of acute pain (post-operative, post-trauma, or similar) should be a concern for both the recovering patient and for those providing care.  Precipitating a relapse for the recovering patient is always possible if pain is not properly managed, but there is very little how-to information in the organized medical literature.

The following are some suggestions for healthcare providers based on available studies, on discussions with physicians and patients, and on the experiences of physicians caring for recovering patients. These observations can help guide adequate, appropriate, and safe treatment of acute pain in recovering patients.

Background

• Recovering patients have a lower pain threshold than non-recovering patients
• Recovering patients are traditionally under-treated for acute pain.
• Recovering patients receiving narcotics may attempt to manipulate the situation to obtain more medication for a longer time than necessary.
• A recovering patient may be very concerned about relapsing, but may or may not acknowledge the fact.
• Dosage has very little to do with precipitating relapse.

Basics

• Know a patient’s previous addiction history.Identify, for example, the drug(s) of choice, when and how recovery started, the quality of recovery, and the timing and circumstances of any relapses.
• Avoid prescribing the patient’s drug(s) of choice
• Use adequate doses to control pain, which may be 25-30% more than doses for non-recovering patient of the same age, sex, weight, and type of operation.
• Use non-narcotics and non-medication techniques when possible.
• Be willing to address patient’s concerns. Involving the patient in the process will assure the patient and family that relapse is neither inevitable nor even likely, as long as the situation is properly addressed.
• Discuss what options are available if active relapse should occur.
• Make use of existing support systems, such as the patient’s AA or NA sponsor.
• Real physiologic withdrawal (not psychological) may occur even after narcotics use as brief as 24 hours, due to cellular memory.

Process

• Meet with the patient and with any others involved in the patient’s recovery.
• Establish as precisely as possible the dosage and frequency of analgesic(s) to be used.
• Establish an appropriate taper schedule from dosages and frequencies, based on the physician’s experience and on the patient’s expected reasonable needs.
• Involve any anesthesiologist in planning pre- and post-operative care (use a clinician in recovery if possible).
• Emphasize NO PRN medication except in unusual, unexpected, or exceptional circumstances (dressing change in a patient with burn injuries, for example).
• If possible, do not discharge a patient who is taking any mood-altering medication.

Caveats

• Many liquid medications contain alcohol, unless labeled or ordered otherwise.
• Plan ahead — most operative procedures are elective (even open-heart procedures may be elective).
• Use local anesthesia when possible (e.g., MARCAN infiltrated into a surgical wound site to decrease post-operative pain.).
• Increase 12-Step meetings before and after any operation.
• Use PCA only with the greatest of reservations, if at all.
• Use regional anesthesia whenever possible.
• Outpatient Prescription Pain Medications: only prescribe the exact number and indicate the frequency needed (e.g., QID x 3 days — dispense only 12). No refills.
• For more information contact The American Chronic Pain Association at www.theacpa.org.