September 9th, 2014

Our guest blog this month features an interview with Dr. Mel Pohl, who specializes in working with addicted patients who are also suffering with chronic pain. Clinicians of all specialties struggle with how best to help these doubly afflicted patients, and Dr. Pohl has provided welcome direction. He is the medical director of Las Vegas Recovery Center and the co-chair of the Pain and Addiction Workgroup of the American Society of Addiction Medicine. Dr. Pohl will be the speaker for this month’s KolmacSchool luncheon program on Thursday as well as a special evening lecture Kolmac Clinic is co-sponsoring with MedChi, the Maryland State Medical Society.

Dr. Mel Pohl has written books for patients and their families, including Pain Recovery: How to Find Balance and Reduce Suffering from Chronic Pain; Pain Recovery for Families: How to Find Balance When Someone Else’s Chronic Pain Becomes Your Problem Too and A Day without Pain. For more information about these publications, visit His new book from Da Capo Books, The Pain Antidote -Stop Suffering from Chronic Pain, Avoid Addiction to Painkillers, and Reclaim Your Life will be available next spring.

Modern Addiction Recovery: Why is there often pessimism about the prognosis for addicts’ recovery?

Mel Pohl: We see so many bad results as a result of the disease of addiction. One bad outcome gives you a taste of the general. We hear more about the negative; it’s more press-worthy. What’s comes to mind? We hear about one celebrity after the other who does badly in rehab. We don’t have a press corps for recovery. Negative outcomes, such as overdose, get more identified with addiction. It’s an uphill battle to de-stigmatize addiction as a disease.

MAR: Is there sometimes even more pessimism about treating addicts who suffer from chronic pain as well?

Mel Pohl: Because of the complications when pain and drug addiction occur in the same patient, addiction professionals don’t see as many positive outcomes from patients with this co-occurring diagnosis. These patients are particularly difficult to treat in traditional addiction treatment programs. Clinicians must develop special skills needed when dealing with chronic pain.

MAR: Why is there reason for optimism in treating patients with co-occurring diagnoses?

Mel Pohl: Recovery Month is all about celebrating recovery, and there’s reason to celebrate. My optimism comes from my experience watching people get well. It’s pretty spectacular to see people recover who have been disabled by pain for decades. For instance, we worked with physician who’s been clean 18 months after 90 days in treatment. And he’s now been elected as president of his state medical society.

MAR: What do you want clinicians to understand about treating these patients?

Mel Pohl: We have a culture where people don’t want to feel pain; they feel like they shouldn’t have to: “I don’t want to feel pain, so give me something.”

Patients with pain can be successful in recovery. Of course, there has to be willingness on their part to try different things – like coming off their medications, learning mindfulness practices and accepting some pain as part of their lives without becoming overwhelmed.

People can also become dependent on pain medications without having true addiction. We treat people who took the drugs as prescribed and did not abuse them; yet they’re finding themselves unable to stop because of being physically dependent on the drug.

In either scenario, the clinician can be an advocate for the patient. The patient feels like they have no voice in the process. If you have someone who is really in trouble, reach out to that prescriber and look for alternatives. Clinicians tell me all the time that physicians won’t talk to them. And I usually respond by saying, “Try anyway and won’t it be exciting if they do?”

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