The pain plan on paper

By the end of this course, you should have a written pain plan you can show to your doctor, your circle, and yourself on a hard day. The plan removes decision-making in moments when your decision-making is most compromised.

The plan has six sections. One: your current pain conditions, listed by name. Two: your tier-one tools — heat, breath, movement, connection — with specifics about where the heating pad is, what breath pattern you use, what walk you take, who you call. Three: your tier-two tools — non-opioid medications, topical treatments, ice, TENS unit, anything else that has been prescribed or recommended. Four: your tier-three tools — when to call your doctor, when to go to urgent care, when to use a specific emergency contact. Five: what is off-limits, written explicitly: 'I do not take opioids of any kind. I do not accept opioid prescriptions even from emergency room doctors. If I am offered one, I refuse and call [name].' Six: who has a copy of this plan and the date you wrote it.

Print three copies. Keep one on your refrigerator. Keep one in your wallet or phone. Give one to your most trusted circle member. Update it every six months as your situation changes.

Why write this down? Because pain narrows your thinking. Pain plus a craving narrows it further. Pain plus a craving plus a tired Wednesday narrows it to a single thought: 'one will not hurt.' A plan on paper, written when you were clear and calm, interrupts that thought.

Most people who relapse from prescription opioids do so after a medical event — a surgery, a dental procedure, a flare-up of the original pain — that put them in front of a prescribing doctor without a plan. With a plan, the same event is survivable. Without one, it is the most predictable relapse vector in addiction.