Dear Therapist:

I am writing regarding my 28-year-old daughter who has a slipped disc. She is in chronic pain and nothing seems to be working (PT, etc.). Surgery has been suggested but we are trying to avoid it because of the inherent risks. My husband and I are becoming more and more concerned about her use of pain medication. Some of the medicine she has been prescribed is highly addictive and we are concerned about her developing a real issue with this. She says she has discussed this with her doctors but that hasn't stopped them from prescribing. There are two aspects to my question: Is there anything else that can be done for her pain that does not involve medication? People have recommended psychotherapy but this is an actual physical ailment that is causing the pain so I am not sure how it could help. Secondly, what can we do to stop her from becoming an addict? What are the warning signs that mean she is developing a real problem? I realize that there is a medical component to this question that not all of you may be comfortable answering but I have gained a lot from your answers in this column through the years and hope you can shed some light on this issue. Thank you!

Response:

My specialties do not include medication or addiction. Although I am somewhat familiar with addiction and with addictive medications, your question is best directed toward a medical doctor who has significant experience with addictions, and is familiar with alternative forms of treatment. Prior to formulating this response, I consulted with the director of a drug and alcohol treatment facility so that I might offer some helpful information.

I assume that your daughter is taking opioid based medication. My understanding is that medical protocol does not recommend use of long-term opioid medication for chronic pain. There are medications that are not opioid based that may also be helpful in managing pain. A pain management expert can help your daughter to take control of her treatment by offering alternatives to the seemingly simple solution—continuous prescribing of opioids.

An enormous number of opioid addictions begin with prescription medication for pain management. It is easy for someone in constant pain to become used to popping pills in order to deal with said pain. Unfortunately, it is also easy to become addicted to opioids. I assume that you do not accompany your daughter to her medical appointments, and that you’re not privy to the information and advice being dispensed. It is very common for people with addictions (or who are becoming addicted) to hide their addictive behavior from others—and specifically from their parents. Even at the point at which someone is a long-term addict, it is possible for those closest to them to be unaware of the extent of the problem.

There are certainly non-pharmacological approaches to pain management, some of which may be helpful in decreasing your daughter’s pain, thereby reducing her supposed need for addictive medications. You mentioned physical therapy. In addition, acupuncture, certain types of injections, and other methods have been successful in treating chronic pain. Pain can be psychological as well. Psychosomatic symptoms can accompany many common ailments, like depression and anxiety, as well as many physical issues that do not directly cause pain.

Despite the fact that there is an obvious source for your daughter’s pain, there may be other contributing factors. It may be helpful for your daughter to see a therapist who deals with chronic pain. In addition, a full physical workup, including blood tests, may unearth an underlying issue that can then be treated.

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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