Chronic pain and addiction have a complicated relationship.
Many people become addicted to their prescription painkillers in an effort to manage chronic pain. They begin with legitimate use, but when the prescribed dose does not effectively manage their pain, they begin to abuse the pills. This can quickly escalate into addiction.
When a person needs addiction treatment and also struggles with chronic pain, this complicates treatment. The person still needs their pain managed, and sometimes, they may still need to use painkillers. This situation requires close supervision from an addiction treatment team and a more tailored program of recovery.
According to a 2017 report from Healthline, even though opioid addiction and overdoses have increased at staggering rates, up to 30 percent of Americans live with chronic pain and their needs are not being met.
The report also says that 33,000 people died of a heroin overdose in the United States in 2015. Out of 135,000 victims of an opioid overdose, only 13 percent were patients who dealt with chronic pain.
Patients who discuss pain with their health care providers are sometimes seen as suspicious because of the public’s perception of opioid addiction today. The media’s coverage of the subject does little good to patients with legitimate pain concerns.
In 2007, Purdue Pharma — the company behind OxyContin, Percocet, and Vicodin — was found guilty of misleading doctors and patients about the habit-forming potential of their medication.
As of 2015, more than one out of three Americans had been prescribed an opioid. This means that many people who were given opioids to deal with chronic pain ended up addicted to the drugs.
A 2015 case study published by Pain found that patients who deal with chronic pain have a complicated relationship with opioids because they both benefit from and reap negative consequences from using these medications.
An August 2017 study published by Substance Abuse Treatment, Prevention, and Policy reported that rates of deaths caused by opioid overdose are now higher than deaths caused by HIV or automobile accidents. A 2009 study published by Substance Abuse found that:
Healthline also mentions a few other things to consider:
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In March 2017, Scientific American published an article highlighting how certain patients became part of the opioid crisis. It described the case of 69-year-old Andrew who was addicted to heroin. Andrew had suffered pain in his joints that ultimately led to having them replaced.
He consistently required surgery in to deal with the pain of these procedures and broke his femur in the bathtub because of an accident. Andrew began using opioids in the 1990s and went from having acute pain to dealing with chronic pain. He also became tolerant of his opioid prescriptions.
One thing led to another and Andrew purchased opioids from a neighbor and then transitioned into heroin. He found help and began managing symptoms with Suboxone, but not everyone is lucky enough to go through an addiction like this and make it out alive.
The American Psychological Association (APA) states there are several alternative ways to deal with chronic pain in patients who exhibit opioid misuse or who just want to avoid taking opioids. A few of their suggestions are:
Harvard Medical School offers suggestions about how to deal with the physical aspects of chronic pain. These include:
In September 2018, BMJ published a study explaining that doctors still use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose the misuse of opiates in patients.
The paper argues that the DSM-5 criteria do not always apply to patients who are in chronic pain. Health care professionals need a more reliable set of criteria to diagnose patients who deal with chronic pain but become addicted to their prescriptions.
Per MedlinePlus, treatment for opioid abuse is generally treated with:
Oftentimes, alternative pain management techniques will be introduced during addiction treatment. Sometimes, this may involve the use of non-opioid pain medications, and for some people, low doses of opioids may still be used.
The treatment team will come up with a personalized plan that best addresses the individual’s situation, treating both their addiction and chronic pain.
(September 2009) The interface between substance abuse and chronic pain management in primary care: A curriculum for medical residents. Substance Abuse. Retrieved April 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821184/
(May 2017) Pan: Brief Description. National Institute on Drug Abuse. Retrieved April 2019 from https://www.drugabuse.gov/related-topics/pain
(March 2017) Case Study: When Chronic Pain Leads to a Dangerous Addiction. Scientific American. Retrieved April 2019 from https://www.scientificamerican.com/article/case-study-when-chronic-pain-leads-to-a-dangerous-addiction/
(September 2018) Diagnosing opioid addiction in people with chronic pain. BMJ. Retrieved April 2019 from https://www.bmj.com/content/362/bmj.k3949.full
(April 2015) Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. Retrieved April 2019 from https://www.ncbi.nlm.nih.gov/pubmed/25785523
(August 2017) Chronic pain and opioid misuse: a review of reviews. Substance Abuse Treatment, Prevention, and Policy. Retrieved April 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558770/
(November 2017) America Is Losing the War on Chronic Pain. Healthline. Retrieved April 2019 from https://www.healthline.com/health-news/america-is-losing-the-war-on-chronic-pain
Coping with Chronic Pain. American Psychological Association. Retrieved April 2019 from https://www.apa.org/helpcenter/chronic-pain
(September 2016) Non-opioid options for managing chronic pain. Harvard Medical School. Retrieved April 2019 from https://www.health.harvard.edu/staying-healthy/non-opioid-options-for-managing-chronic-pain
(November 2018) Opioid Abuse and Addiction Treatment. MedlinePlus. Retrieved April 2019 from https://medlineplus.gov/opioidabuseandaddictiontreatment.html