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How Does Polypharmacy Impact Chronic Pain Management?

In pain management, there are moments when the source of the problem eludes even the most seasoned healthcare professionals. Take the case of Sarah, a 55-year-old woman who has been experiencing chronic lower back pain for years. Despite numerous diagnostic tests and consultations with specialists, the exact cause of her pain remains unclear. Frustrated and desperate for relief, Sarah finds herself on a journey through a maze of treatments, including medications.

Sarah's treatment regimen includes a combination of non-opioid analgesics, muscle relaxants, and anticonvulsants to manage her pain and associated symptoms. However, as her pain persists, her healthcare providers introduce opioid medications into her regimen in an attempt to provide additional relief. Alongside these medications, Sarah's pain management providers prescribe mental health medications to address the anxiety and depression that have arisen from her chronic pain, and they do so without psychological assessments.

However, while these medications may offer temporary relief for Sarah, their cumulative effects pose significant risks. The combination of opioids, muscle relaxants, anticonvulsants, and antidepressants increases Sarah's risk of adverse effects, drug interactions, and complications. Despite her healthcare providers' best intentions, Sarah finds herself grappling with drowsiness, cognitive impairment, and diminished quality of life.

Sarah's story underscores the complexity of polypharmacy in pain management and the challenges it presents for patients and healthcare providers alike.

Polypharmacy is the simultaneous use of multiple drugs by a single patient for one or more conditions. It increases the risk of adverse drug-drug or drug-disease interactions and the risk of a “prescription cascade” (ie, the process whereby side effects of drugs are misdiagnosed as symptoms of another medical event and lead to an additional prescription).

While medications have the potential to alleviate symptoms for certain individuals, the indiscriminate administration of multiple drugs without addressing the root cause of pain can precipitate unforeseen repercussions. This approach often masks the underlying issues without offering sustainable solutions, potentially exacerbating the patient's condition.

Failure to identify and treat the source of pain may result in prolonged suffering, heightened dependency on medications, and increased susceptibility to adverse effects and complications. Therefore, a comprehensive and targeted approach that prioritizes uncovering the root cause of pain is essential for effective long-term pain relief and improved outcomes.

In cases where the root cause of pain remains elusive despite thorough evaluation, it's crucial to consider the possibility of neuroplastic pain as a contributing factor.

Neuroplastic pain is a multifaceted condition characterized by alterations in the nervous system's structure and function. These changes occur due to reflexive and adaptive adjustments in the brain and spinal cord triggered by neuroception.

Neuroception refers to the nervous system's continuous assessment of potential threats and safety cues, which prompts physiological changes. In simpler terms, neuroplastic pain occurs when the nervous system undergoes shifts in response to its perception of risk and safety, leading to changes in how pain is experienced and processed.

This rewiring of neural circuits can perpetuate the experience of pain even after the initial tissue damage has healed, leading to a chronic pain condition that defies conventional biomedical approaches like medications, injections, and surgeries.

Acknowledging neuroplastic pain as a possible root cause highlights the significance of embracing comprehensive and multifaceted approaches that address both the origin of pain and the enhancement of neural plasticity and function. In essence, it emphasizes the need for strategies that not only alleviate pain but also promote the brain and nervous system's ability to adapt and heal.

When clients first seek assistance from a pain coach, they often find themselves struggling with polypharmacy. As they start making changes through neuroplasticity, they may discover they're taking numerous medications they never required. As a pain coach, I cannot help them navigate this difficult path. Unfortunately, limited solutions and resources are available for individuals facing this dilemma.

For pain management professionals, acknowledging the complexities of polypharmacy in chronic pain management is vital. Collaborating with pain coaches, such as those at My Pain Coach, LLC, who provide comprehensive, personalized, evidence-based approaches, can be invaluable. Moreover, integrating pain-informed psychologists into the treatment team can offer essential support for addressing the psychological aspects of pain.

Together, let's address polypharmacy through a biopsychosocial model of care and ensure patients receive the multidisciplinary care they require to find pain relief.

Contact us today to begin your journey toward a pain-free life. We specialize in assisting individuals enduring the frustration of chronic pain, guiding them to uncover their personalized MPC Pain-Free Formula™. We aim to facilitate recovery or substantially reduce pain, enabling individuals to engage in life again. Regardless of the duration of your chronic pain, let us support you in rebuilding and reclaiming a fulfilling life.

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Cynthia Austin, NBC-HWC


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