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.
Opioid Abuse and Chronic Pain
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 — were 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.
Addiction Rates in People with Chronic Pain
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.
- The case study found that between 1 to 81 percent of patients used their opioids in a problematic manner.
- Between 21 and 29 percent of patients misused their prescriptions.
- Between 8 and 12 percent of patients were addicted to their prescriptions.
An August 2017 study published by Substance Abuse Treatment, Prevention, and Policyreported 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 Abusefound that:
- Lower back pain is associated with higher incidences of opioid prescriptions.
- Doctors need to learn the difference between drug-seeking behavior and pain that is not treated correctly.
- Patients who receive a test that is positive for illicit sources of opiates should be prescribed buprenorphine or another medication to wean themselves of opioid abuse.
Healthline also mentions a few other things to consider:
- Many patients who use opioids for chronic pain do not experience full relief, and they experience side effects such as constipation.
- Care that is tailored to a patient’s needs may be more successful in treating chronic pain.
- Some people avoid opioids because they are afraid of becoming addicted.
A Case Study
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.
Various Methods that Address Chronic Pain
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:
- Find a support group. It can be difficult for patients to go through the motions of pain on their own. Local support groups often exist where they can connect with like-minded individuals who are going through the same thing they are.
- Ask a professional for help. Talking to a psychiatrist or psychologist could help patients learn the skills necessary to handle the mental burden of their chronic pain.
- Find effective ways to deal with stress. APA says that it is important to eat a nutritious diet, get enough sleep, and make sure you get enough exercise if you are dealing with chronic pain and stress. This is because emotional and physical pain influence each other, and decreasing emotional pain is an effective way to deal with chronic pain.
- Distract yourself. It is important not to withdraw from others, as this makes it easier to focus on negative thoughts brought on by chronic pain. Instead, try to find a pastime or hobby that allows you to do something constructive. You can involve your friends and family or spend time alone as long as you work on something constructive.
- Focus on positive self-talk. Tell yourself that you are working on leading a more rewarding life and focus on any progress you make on your health.
Harvard Medical School offers suggestions about how to deal with the physical aspects of chronic pain. These include:
- Hot and cold therapy. Heat can relax muscles and increase your ability to tolerate pain. Cold therapy is soothing after an injury.
- Losing weight. For some people, pain is exacerbated by excess weight. Weight loss can alleviate pain caused or worsened by additional pounds.
- Massages. These can relax joints or muscles undergoing stress. They may also prevent certain pain signals from reaching the brain.
- Assistive devices. If appropriate, it may be wise to use an assistive device, such as a brace, cane, or splint, to deal with chronic pain.
- Topical medication. Such medication relieves pain when applied directly onto the skin. You can ask your doctor if these can be added to your regimen.
Treatment for People With Addiction and Chronic Pain
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:
- Behavioral therapy or counseling
- Medication-assisted treatment (MAT) that can include substitutes like methadone or buprenorphine to alleviate pain while tapering from medications of misuse
- Inpatient or residential treatment
- Intensive outpatient treatment that addresses both substance misuse and health issues
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.