Bayside Marin primarily functions as a residential treatment center for chemical dependency. Chronic pain — which is characterized as pain symptoms that last longer than three months in a specific area — often goes hand-in-hand with an addiction to drugs or alcohol.
“Anywhere from 20 to 30 percent of people with opiate dependence and chronic pain have developed a chemical dependency or an addiction to pain medications,” said Bayside Marin’s Director of Health Services, Ray Deutsch, MD.
Bayside Marin is a chemical dependency treatment program but has the staff and expertise to treat opiate-dependent patients with a chronic pain syndrome. Studies have shown that reductions in pain levels of 30 percent are sufficient to allow people to function in their daily lives.
Patients who enter Bayside Marin with opiate dependence and a chronic pain syndrome are asked to rate their pain on a scale of one to 10. Upon admission, most patients report a pain level of at least seven. By the time they leave (usually about 45 days later), most patients report experiencing pain levels of five or below, which is usually sufficient to allow them to function in their daily lives.
A chronic pain syndrome is defined as a pain syndrome that lasts more than 100 days. This type of pain is generally not curable, although it may be manageable through various treatments.
“Our goal is to reduce the pain to a manageable level and to achieve improved function,” Deutsch said. “Our goal is not to cure pain – if it was going to be cured, it would have been cured already.”
The treatment team at Bayside Marin does not diagnose a patient’s pain symptoms. “The primary diagnosis is made by the referring physicians,” Deutsch said. “Because chronic pain by definition is not curable, our goal is education and treatment.”
Criteria for Admission
The criteria for admission with chronic pain to Bayside Marin are based on a departure from the way in which the pain medications are supposed to be taken or how they were prescribed. Some examples include using more pain medication than prescribed or obtaining the medication in inappropriate ways (such as stealing somebody else’s pills, getting multiple doctors to provide prescriptions, or buying opiate pain medications online or on the street).
Many patients may not meet the criteria for an addiction to opiate painkillers, but can be admitted for a dependence on the drugs. A dependence on painkillers is characterized by a tolerance to the drugs that is abnormal. For example, someone with chronic pain may find themselves experiencing little pain relief with their prescribed dosage or needing to increase their dosage to achieve the same effect.
Treating Chronic Pain
The treatment of chronic pain at Bayside Marin involves techniques to reduce pain levels as much as possible to a tolerable level and to improve function.
Treatment includes psychotherapy, relaxation techniques, Qigong, acupuncture and physical therapy. These treatments alone can help patients achieve a significant reduction in pain levels.
“Pain is a symptom, an internal receptor of discomfort,” Deutsch said. “So, for example, if patients deal with their stress, their headaches may resolve.”
While treatment can go a long way to relieving pain, health treatment of opiate addiction is very important and may make up a significant part of a patient’s chronic pain treatment.
Patients are first required to detox from the opiates they are addicted to or dependent on through the use of various medications. One of those is Suboxone, a partial opiate that can reduce or eliminate withdrawal symptoms. Suboxone can be used on a chronic basis to prevent relapse and to ameliorate pain because it is analgesic in itself. Suboxone acts as a substitute for the abused opiate but is non-addictive.
Along with detox, patients are prescribed a number of other medications that may include analgesics such as an anti-inflammatory to ease local pain symptoms or an anti-depressant. These serve to help reduce pain levels and make pain more manageable without patients feeling the need to return to the use of opiates.
After they have completed their inpatient treatment at Bayside Marin, patients are provided an aftercare treatment program with a number of treatment options, including individual and group therapy, access to 12-Step treatment and access to local physicians who can prescribe medications.