N.O.R.M.A.L.: Neuroplastic Optimization and Reduction of Medication for Adaptive Living
(Workbook Page 14)
The polypharmacy of pain treatment is criticized for side effects, drug-drug interactions, worsening pain states, dependency, addiction and even inadvertent death. The problem is not with the medications, but in the way they are utilized to treat persistent pain. They have become the core treatment for this disease process. If the dynamics of persistent pain are recognized as a neuroplastic process, we must view neuroplasticity as the basis for persistent pain and it’s treatment. All treatment should be aimed at creating neuroplastic change to oppose and halt the process of persistent pain. Medications are an excellent way to alleviate symptoms while working on the underlying cause, but cannot be the mainstay or central principle of any treatment program. They are a spoke in the wheel of treatment options with neuroplastic treatment at the center.
People living with persistent pain often end up on a long list of medications designed to treat a host of pain-related symptoms and medication-induced side effects. Over time, this becomes the primary treatment people receive. While medications can be effective alone and in combination, they have many drawbacks.
Medication management often promotes a passive patient model of care and undermines people taking an active role in their own recovery. The body and brain adjust to the medications, and they become less effective. Visits to pain practitioners then consist of changing or rearranging medication regimens. Patients may improve for a time, but a vicious cycle of short-term improvement with subsequent worsening of symptoms occurs due to tolerance, requiring more medication. Side effects and drug-drug interactions further complicate the situation, and the body’s own ability to stabilize, rebalance and return to normal is impaired. It reaches a point where it is unclear whether a patient’s problems are due to their underlying pain disorder or the effects of long-term medication use.
By design, medications mask symptoms. It is these very symptoms that provide the clues to possible treatment solutions. By relying on medications every time pain increases, the opportunity to evaluate other pain relieving treatment options is lost. Anxiety and a fear of pain ensue rather than a sense of curiosity about what is happening and what might help. People maintained on chronic medications tend to do less, contract their lives, sense and report higher pain, depression and anxiety levels. Mutual patient and practitioner goals should be the prudent reduction of medications within a more active, patient-centered program based on neuroplasticity.
Medications can then take their rightful place and be used most effectively. They play a prominent role in the Rescue and Adaptation phases of treatment and take on a secondary role when the patient advances to the Restoration and Transformation phases. In the Restoration and Transformation phases patients are actively applying neuroplasticity techniques to change their pain and medications can be used as needed for relief of symptom exacerbation
As part of the Neuroplastic Transformation treatment program, the gradual and thoughtful reduction of medications is employed. It is called Neuroplastic Optimization and Reduction of Medication for Adaptive Living or N.O.R.M.A.L. When people take control of the neuroplastic processes that created the pain disorder, pain decreases and a great sense of self-control replaces the feeling of being the victim of persistent pain. At this point, medications can be reduced gradually and continued neuroplastic approaches can hone and improve self-directed pain and mood control guiding the process of transformational living through pleasurable experience.