Coping With Withdrawal
Aside from treatments, there are other ways in which you can support yourself as you go through the withdrawal process.
Support
You must have support, ideally personally as well as professionally. If you can reach out to loved ones and let them know what you are going through so that they can be there for you, this can be helpful. The withdrawal process can be taxing emotionally as well as mentally, so having people there to cheer you on and encourage you can make all the difference.
If you find that you are struggling during withdrawal, speak to your doctor or health care team. They might be able to give you extra guidance and support to ensure you’re able to see the process through. You mustn’t give up, instead speak up!
Distraction
As hard as it might seem, distracting yourself as much as possible can be a great coping tool. This can help to take the focus away from pain and other withdrawal symptoms and provide some relief. You could:
- Listen to relaxing or uplifting music
- Read a book or if you can’t focus enough to read, listen to an audiobook
- Watch a fun film, TV series, or a documentary
- Chat with a friend or family member on the phone
- Play video games or board games
- Do some crafts like painting, drawing, or knitting
- Change the environment to shift your mindset, even if it’s just walking into another room
Small, regular meals
You might not feel like eating, but you must try. Small, regular meals can be useful. Plain, bland foods are best as they are least likely to cause stomach upset. This could include toast, crackers, rice, or some fruit.
Lots Of Fluids
It’s so important to stay hydrated when experiencing withdrawal symptoms. Take regular small sips of water, juice, or a warm drink throughout the day rather than gulping down water, to reduce the risk of vomiting. You could also choose to replace lost electrolytes with sports drinks or electrolyte replacement drinks. However, be aware these could aggravate diarrhea.
Heat And Cold To Manage Pain
Using heat pads, wheat packs that you heat in the microwave, or a hot water bottle, can be a great way to ease muscle aches and pains. It can also be comforting and calming. Some wheat packs have a comforting lavender scent. Likewise, using cold packs can help to reduce inflammation and pain.
Topical Analgesics
You can buy topical analgesics over the counter which are typically creams or gels which you rub onto your skin. Some create a cooling, tingling sensation and interrupt pain signals, providing some relief. Others create a heating sensation along with the same effect. Some provide a mild numbing effect to ease painful areas.
Moderate Exercise
Exercising can help to provide a distraction, along with raising your mood, easing pain and muscle stiffness, and helping you to sleep more peacefully. You shouldn’t overdo exercise when you’re going through withdrawal, but some moderate exercise such as walking or stretching can be a great coping technique.
Sleep Hygiene
It can be really difficult to sleep when you’re experiencing withdrawal symptoms and when dealing with chronic pain, but good sleep hygiene can help you to get the rest you need. Sleep hygiene refers to positive habits to increase your chances of sleep. This can include going to bed and getting up at roughly the same time each day; making your bedroom comfortable and relaxing; winding down before bed; and using relaxation techniques.
Remembering Your End Goal
There’s no denying that withdrawal is hard, so you must keep reminding yourself of why you’re doing this. You could come up with positive mantras to repeat to yourself (in your mind or out loud) to help you remember your end goal even when it’s difficult. Some examples of mantras could include: “It’s hard right now, but I can do this and it will be worth it” and “I will not give up, this is for my good and to improve my life.”
You could also choose to focus on the future to keep you motivated: think about what you are going to do once you’ve completed your withdrawal. You could create a vision board or write down your goals to keep you focused on moving forward.
Follow Up Care
Once the acute withdrawal phase is complete, you need to learn to live without opioids. This can be tough but is possible. The post-acute withdrawal period can last up to two years: this doesn’t mean you will be experiencing severe withdrawal symptoms the whole time. It simply means you may find it difficult to adjust to life and living with chronic pain without opioids, and may experience changes in mood, anxiety, and stress levels.
The post-acute withdrawal period can lead to problems sleeping, and concentrating, and a decline in general mental health. It’s during this stage that you may find it most difficult not to go back to taking opioids, so you must have the appropriate follow-up care.
Maintenance Treatments
Depending on your care plan and the medications used to assist you through withdrawal, you may continue to take medications as maintenance. These can include methadone and buprenorphine for example. The long-term aim is to withdraw from these medications completely too.
It may appear counterintuitive to replace one opioid with another, but it’s all about a gradual withdrawal process that is manageable for the patient, with the end goal of being opioid-free. Replacing an opioid that is extremely hard to withdraw from and is very addictive, with one which is less addictive and easier to withdraw from, is a step towards being opioid-free.
This report from the National Institute on Drug Use explains that “these medications do not produce a euphoric high but instead minimize withdrawal symptoms and cravings. This makes it possible for the patient to function normally, attend school or work, and participate in other forms of treatment or recovery support services to help them become free of their substance use disorder over time.”
Naltrexone is commonly used in the months after withdrawal to reduce the likelihood of relapse. As we mentioned earlier, naltrexone is an opioid blocker. It can be used after withdrawal is completed as part of an ongoing management plan to reduce opioid cravings.
Monitoring
Just as you were monitored during withdrawal, you should be monitored after your acute withdrawal phase is over. This should entail regularly seeing your doctor or someone from your health team to check how you’re doing. They should ensure you’re coping and are not at risk of relapsing. They should also signpost you to other services which may be able to help support you if you’re struggling.
Cognitive Behavioral Therapy (CBT)
CBT is often used as part of follow-up care to help aid patients in continuing with positive coping strategies and thought processes in the long term. CBT can help patients to adjust to life without opioids and can reduce the risk of relapse.
Introduction To Other Chronic Pain Treatment Options
One of the biggest parts of follow-up care is to replace the need for opioids by providing you with other chronic pain treatment options. Opioids don’t solve the problem of chronic pain; they only mask it while they’re being taken. Once you’ve withdrawn from opioids, you will be able to feel the full effects of your chronic pain again.
Patients should not withdraw from opioids and then be left in chronic pain, as understandably this exponentially increases the risk of them returning to opioids. Instead, they should be educated and signposted to scientifically proven treatments which rather than masking chronic pain, actually help them to overcome their pain in the long term.
Psychological treatments - There is a range of psychological treatments, meaning talking-based therapies, which can not only help you to better manage your chronic pain but reduce chronic pain symptoms. Pain neuroscience education (PNE) is a cornerstone of many of these treatments. PNE teaches you the science behind chronic pain so that you fear it less and understand why and how treatments work.
Some effective psychological treatments include:
- Cognitive Behavioral Therapy (CBT)
CBT isn’t just useful during the withdrawal process but can help to treat chronic pain. Through CBT you can learn to replace negative perceptions of pain and behaviors which may be perpetuating chronic pain, with positive helpful thoughts and behaviors which actively reduce your pain levels.
- Acceptance and Commitment Therapy (ACT)
ACT helps you to let negative thoughts pass you by, teaching you that negative thoughts don’t need to lead to actions. You are then guided through committing to more positive coping strategies.
- Mindfulness
As with CBT, mindfulness isn’t only valid during the withdrawal process. It can be helpful in the ongoing treatment of chronic pain by lowering stress levels and breaking the stress and pain cycle.
- Graded Exposure Therapy
Graded exposure therapy helps patients to face the fears and movements they have been avoiding in a gradual, manageable way. The brain learns that these movements do not need to produce pain messages, therefore retraining the brain away from chronic pain.
- Graded Motor Imagery (GMI)
GMI uses imagined movements to retrain the brain gradually away from pain, teaching the brain that it no longer needs to produce chronic pain messages. These imagined movements can then be transitioned into physically performing the exercises.
Manual and physical therapies - Manual and physical therapies involve movement and hands-on treatment to ease chronic pain. These therapies include:
- Massage - Massage can alleviate muscle tension and reduce stress.
- Physical therapy - You’ll also hear this referred to as physiotherapy. This involves exercises to improve your range of movement, learning how to move your body safely, increasing your levels of functioning, and strengthening your body.
- Hydrotherapy - Hydrotherapy involves doing exercises in a heated pool of water. The water takes the weight off your joints making movement easier, and the heat eases muscle pain and stiffness.
Self-management - Patients should be educated in effective self-management techniques to improve their quality of life between therapy appointments. These can include eating well; pacing activity; doing exercise; practicing good sleep hygiene; reducing stress and more.
Opioid use in the future
While once you withdraw from opioids it’s important not to restart them for chronic pain, in the future there is a chance that you may be offered opioids for acute pain if you have an accident or injury. In this circumstance, it’s always a good idea to speak up and explain your past situation to medical staff.
If you were able to successfully taper off your opioids and have maintained this, your doctor may monitor you more closely but it may be safe for you to take opioids in the short term. If you struggled with addiction and found withdrawal very difficult, or have had relapses, your doctor may look at alternative pain control.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
