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Pain Management and Addiction: What are the Risks?

Pain and addiction are linked at the hip in more ways than you would think. When you hear the words “pain” and “addiction” in the same sentence, you might think we’re talking about the pain of addiction itself. That’s a fair assumption, as addiction does cause physical and emotional pain in both the addict themselves and those close to them. But we’re not talking about the times when addiction leads to pain. Instead, we’re talking about the opposite – when pain leads to addiction. This is something that is happening increasingly, and at epidemic levels. If you’ve heard talk about “prescription drug” abuse or addiction, that probably has something to do with pain management. But what do we mean by “pain management,” and why would something like that lead to addiction? Isn’t feeling less pain a good thing? Well, yes and no. Chronic pain is an awful condition that nobody should have to live with, but many do, through no fault of their own. But the substances that are available for treating pain have some pretty serious tradeoffs. Let’s go over some of the key information you need to know about pain management and addiction. It’s important to know what pain management is, what substances are associated with it, and what those substances do to your body. With that information, you will be better prepared to navigate the tightrope between chronic pain and drug addiction known as pain management.

What Does Pain Management Actually Mean?

At the most basic, innocuous level, pain management is a simple and harmless exercise. Your back hurts after mowing the lawn, so you take some Advil. You come down with a headache, so you take some Tylenol. That’s all pain management means, in the medical sense. It’s taking medications to dull or eliminate a nagging pain that you would otherwise feel. Pain management drugs, or simply painkillers, do their jobs and reduce the pain you feel, which is a good thing. But this is a situation that scales up very quickly. It’s all well and good to take over-the-counter medications in moderation and as directed, in response to minor aches and pains. Those are generally temporary ailments that are not serious and do not affect your quality of life in the long term. But what about chronic pain that never leaves? The kind of pain that comes from serious injury, arthritis, and other medical conditions? That’s not something that goes away with a couple of over-the-counter pills. That requires constant medical attention, therapy, and strong medications. Luckily, modern medicine has identified a number of powerful medications that can improve the lives of those living in pain every day. Unfortunately, painkilling substances tend to work by flooding the brain with chemicals that make it stop sending pain signals, or at least ignore them temporarily. And substances that do that tend to be highly addictive. Pain management specialists and pain clinics have popped up to help people deal with chronic pain. Why? Because properly managing extreme and extended pain is something that is extremely delicate. Medical professionals dealing with prescription-grade painkillers must be extremely careful with who they prescribe what substance to, and in what quantities, as addiction or even fatal overdoses lie in wait if the substances are improperly used.

What Substances Are Used for Pain Management?

The most notorious and common substances used for relief of chronic, severe pain are prescription opioids. Some of the more common opioids used in pain relief include:

  • oxycodone (OxyContin)
  • methadone
  • hydrocodone (Vicodin)
  • fentanyl
  • morphine

These substances are effective in that they allow people with consistent pain to get relief from what is otherwise near-constant suffering. However, when used repeatedly, they can trigger cravings to use simply for pleasure. This is where the trouble starts. First, opioids are used to remove negative feelings (pain). Then they start to see use for positive feelings (the dopamine rush to the brain). This represents a misuse of this or any other drug. Continuing on that path of abuse can lead to a serious dependency. The problem with prescription drug addiction and dependency is that they are expensive, and not particularly available illicitly. They can be found, but not easily. So what happens when a person becomes addicted to painkillers, but their supply runs dry? Do they simply “dry out,” without the drugs to keep them going? Usually, no. It’s not that simple. Many people turn to a replacement substance that is much more readily available, cheaper, and has nearly the same effect as the painkiller they got hooked on. That substance is heroin. Heroin, like oxycodone and methadone, is an opioid. Heroin and prescription painkillers have nearly identical effects on the human body, so desperate people who get hooked on perfectly legal prescriptions may find themselves with nowhere to turn but to continue getting their fix illicitly. When you’re suffering from addiction, simply not using isn’t a viable option. Addiction doesn’t work that way. Addiction breaks down your ability to prioritize anything above getting more of the substance you’re on. So whatever consequences may result from your use, even if you feel like you want to be done with it, the impulse to find more will eventually before to great to resist. Even going outside the law isn’t too great a risk at this point. Because of this connection, you can’t talk about prescription painkillers without also discussing the impact of the substances that can end up informally replacing them. Even marijuana is often used as a painkiller and can be prescribed as such in a majority of U.S. states. However, the effects of marijuana and opioids are not similar enough for there to be a strong link between prescription drug abuse and marijuana use.

The Vicious Cycle of Pain Management and Addiction

Addiction in those who suffer from some form of chronic pain is much more difficult to manage than it would be for other addicts. That’s because most of the time, addiction is at the core of the addict’s problems. It may not be the cause, but it’s right there, aggravating the problem. As a result, it’s a good thing to relieve someone of their addiction, working with them to develop strategies and understandings about their substance abuse. There are basically no downsides to eliminating the substance from their life because that substance is actively making everything much worse. With pain sufferers, things are a bit different. Being addicted to the drug is still a bad thing, and no matter what good it may do, once dependency is established, the users completely loses control of their life. But in these cases, even if the user beats their addiction and quits painkillers for good… they still have the pain to deal with. There is no getting around the fact that they are going to be living in pain. The only reason they became addicted in the first place is that they needed the substance to deal with the pain. This is a classic “rock and a hard place” dilemma. Is it better to deal with the pain of addiction or the pain of physical ailments? Both are pretty terrible options, which is part of the reason this is such a difficult cycle to break. People who actually go through detox and rehab for Perhaps the biggest problem is that addiction, too, is a chronic issue. You might think that someone can simply work themselves out of the “addicted” stage of painkiller use, then simply start using as directed, or perhaps using a slightly different substance, right? That isn’t the case at all. Once someone’s brain and body have been primed for addiction, they’re more susceptible to it for the rest of their lives. Normally, that plays out in terms of someone needing to stay away from recreational drugs and alcohol. But in the case of someone addicted to painkillers, that means they need to stay away from the substance they were using to make their daily pain a little less awful. They can’t go back to using “normally” or “as directed.” A single use of any opioid, regardless of whether or not it was the same type as they were using before, will send them directly back into the pit of addiction and dependency. That’s because the body never fully recovers from addiction. It can’t be cured, only managed – just like chronic pain. But once things get to this point, it seems like people who suffer have to choose one or the other – pain or dependency.

Breaking the Pain and Addiction Cycle

There is no simple answer to how to manage pain and addiction when both are present. Once both conditions exist, it’s likely that one or the other will perpetually be a problem, if not both. But, one of the best ways to deal with this problem is to prevent it. And one of the best ways to prevent it is to know how to recognize the warning signs of addiction and what not to do what you’re taking potentially addictive medications. First off, know what you’re taking. We’ve already listed a number of names of opioid drugs used to fight pain, but the drugs you’re taking are rarely named for their ingredients. OxyContin, Percoset, and Vicodin are some of the most common prescription opioids, but there are dozens of others to watch out for. Make sure to talk to your doctor about what you’re taking and what the risks are. Second, be sure to always, always, always use prescription drugs exactly as directed. People have a tendency to “self-medicate,” especially with painkillers. They think that the proper way to use a painkiller is to consume it as a response to pain. It’s true that some painkillers will tell you to take the substance “as needed,” but there are also usage limits and restrictions to ensure you don’t take too much. Taking these medications simply when you feel like it can lead to the next logical step – taking it because you want to, not because you need it. That’s getting into the realm of substance abuse, and at that point, addiction is right around the corner. Finally, stay aware of the signs of opioid addiction, and talk to your doctor immediately if you notice them starting to crop up. This is perhaps the most difficult step since one of the features of addiction is the denial of a problem. But if you know the potential risks of these substances beforehand, you are more likely to recognize the symptoms before they grip you. What are your experiences with pain management and painkillers? Have you had run-ins with prescription opioids? How did you deal with them, and what are some of your strategies for walking this tightrope? Let us know in the comments below.