Pain Management and Addiction
Am I Addicted to Painkillers?
It can be difficult to know when you’ve crossed the line from managing your pain to abusing your medication. Signs include:
- Neglecting your responsibilities in favor of using painkillers.
- Taking more than prescribed, or snorting or injecting the drugs.
- Visiting multiple doctors for prescriptions.
There are a lot of popular misconceptions surrounding pain management and addiction. Many doctors are reluctant to prescribe scheduled pain medications like Vicodin, Percocet or Darvocet because they worry about their patients becoming addicted to these analgesics. Some medical professionals are willing to prescribe controlled pain medications to patients who are being treated for cancer or under hospice care, but they’re cautious about prescribing to patients who suffer from acute pain caused by a car accident, arthritis or a spinal cord injury.
If you feel frustrated by your efforts to get a doctor to adequately treat your pain, or you’re self-medicating because you can’t get the pain relief you need from a physician, you’re not alone. Effective pain management requires an understanding of the nature of chronic pain, a willingness to listen to the patient’s reports of discomfort and the ability to distinguish between drug tolerance and dependence.
Doctors who specialize in pain management are often the best source of treatment for people whose lives have been severely restricted by injury or illness. The most dangerous, least effective approach to pain management is to medicate yourself with powerful, potentially habit-forming drugs and alcohol.
*How Chronic Pain Can Affect Your Life
Chronic pain caused by an accident, illness or disability can touch every aspect of your life, from your daily activities to your personal relationships to your plans for the future. The American Pain Medication Society reports these statistics from the 2006 Voices of Pain Survey, conducted by the American Pain Foundation:
- Over 50 percent of the 303 people who responded to the survey said that their pain wasn’t under control.
- Almost 60 percent said that their pain took away from their enjoyment of life.
- About 77 percent reported that they were depressed.
- Approximately 86 percent said that their pain interfered with their sleep.
- About 74 percent said that their activity level was reduced because of pain.
4 Myths About Pain Management
Getting the facts about pain management can empower you to get the help you need to control chronic pain without developing an addiction. When you’re looking for ways to manage your pain, you may find that these common myths get in your way:
- Anyone who gets a prescription for opioid pain medication will probably become addicted. Although it’s possible to develop an addiction to pain medications like Percocet, Vicodin or OxyContin while being treated for chronic pain, clinical research shows that most patients whose pain is being properly controlled do not develop addictive behavior. According to pain specialist Jennifer Schneider, MD, PhD, drug-seeking behavior in chronic pain patients is not necessarily a sign of addiction, but a sign that their pain is being undertreated.
- Chronic pain patients often exaggerate their pain in order to get higher doses of opioid medications. Pain is a subjective experience, and one person’s response to chronic discomfort may be very different from another’s. Pain management specialists know that the patient’s report of pain is the most accurate indication of the level of discomfort that he or she is experiencing.
- The goal of pain management is to wean patients off habit-forming drugs. Although tapering down the dose of pain medication may sometimes be warranted, the goals of pain management should really be to help patients achieve their optimal physical function while providing maximum relief of pain. Many chronic pain patients function more effectively with high doses of opioid medication; weaning them off the drug may not be possible without restricting their activity level.
- Patients who have a history of drug or alcohol addiction should not be prescribed opioid pain medications. Doctors must use caution and provide careful supervision when prescribing opioids to patients with a history of substance abuse or dependence. But non-scheduled pain medications don’t always provide adequate relief, and undertreating a recovering addict’s pain may drive the patient to self-medicate with drugs or alcohol. According to the Journal of Clinical Psychiatry, the patient’s level of pain should determine the strength of the pain relief provided, regardless of the patient’s addiction history.
Tolerance, Dependence and Addiction
For chronic pain patients, it’s especially important to make a distinction between tolerance and dependence, and between dependence and addiction. Tolerance means that the patient has reached a point where he or she may need a higher dose of pain medication in order to meet pain relief goals. A patient may become tolerant to a medication after taking a specific dose for a certain period of time. On the other hand, many chronic pain patients take the same dose of opioid medication for months or years without requiring an adjustment.
Dependence indicates that the patient needs the drug in order to function physically or psychologically. With chronic pain patients, it isn’t unusual to develop a dependence on an opioid drug. The National Institutes of Health notes that stopping an opioid medication abruptly can cause withdrawal symptoms such as:
- Anxiety and agitation
- Increased pain
- Sleep disturbances
- Stomach cramps
- Nausea and vomiting
If you’re taking a prescription opioid medication to control chronic pain, you shouldn’t stop taking the drug without your doctor’s supervision. The drug should be tapered off gradually to avoid withdrawal symptoms and ensure effective pain management.
The word “addiction” is sometimes used interchangeably with “dependence,” but the two conditions are very different. The hallmarks of addiction are:
- Persistent use of the drug, even though it’s causing harm to your health, career or relationships
- Repeated attempts to cut down or stop using the drug without success
- A fixation on getting and using the drug at the expense of any other interests, obligations or relationships
Some chronic pain patients do become addicted to opiates after being prescribed pain medication by a doctor. But most problems with addiction begin when the patient takes pain control into her own hands instead of working with a competent, qualified pain specialist. Combining prescription pain medications with alcohol is even more dangerous and may lead to a fatal overdose.
*Warning Signs of Prescription Drug Addiction
When you take habit-forming pain medications every day, it may be difficult to know when you’ve crossed the line between dependence and addiction. A patient who’s become addicted to a prescription drug may:
- Consistently request that prescriptions be refilled early
- Show signs of drug or alcohol abuse or fail to pass drug screenings
- Have interpersonal problems with family members or have trouble at work due to drug use
- Display aggressive or violent behavior when a request for an early refill or a dose adjustment is refused
- Inject pain medications that are meant to be taken orally
Creating a Pain Management Agreement
While doctors have a responsibility for making sure that their patients’ pain is adequately treated, they’re also responsible for their patients’ health and safety. Physicians who manage chronic pain often draw up a pain management contract that establishes rules and restrictions. In a typical contract, a patient may agree to:
- Get pain medication from only one prescribing doctor
- Have pain medication prescriptions filled by one pharmacy
- Inform the doctor before modifying the dose of pain medication
- Take drug or alcohol tests if required
- Refrain from abusing drugs or alcohol
- Provide medical records from any other doctors
A standard pain management agreement will also list the patient’s rights, including:
- The right to effective pain control or prevention
- The right to have complete information about the medications that you’re taking
- The right to participate in decisions about your treatment
- The right to know about non-pharmaceutical pain management options
- The right to receive pain medication in a timely manner
- The right to refuse treatment
Pain medication contracts are not a foolproof way to prevent dependence or addiction, cautions WebMD. But setting out written rules for the patient to follow makes the doctor’s expectations clear and prevents misunderstandings that may lead to under-treatment or drug abuse.
Pain Management in Addiction Treatment
When the drugs you’re taking to manage pain become a risk to your health and well-being, it’s time to seek help. Addiction treatment programs that focus on chronic pain management can help you find safer alternatives to self-medication. If necessary, you may go through a supervised detoxification program to minimize withdrawal symptoms. Medical professionals will evaluate your current pain management plan in order to develop a healthier way to maximize your physical function. Comprehensive treatment programs address not only the physical causes of pain, but its psychological and social dimensions.
If you’re suffering from restricted activity, social isolation, underemployment and depression due to chronic pain, self-medication may seem like the only option. In fact, compassionate care is available from professionals who understand the challenges that you face when you’re coping with lifelong pain and addiction. For information on rehab programs that address chronic pain as well as drug dependence and addiction, call the toll-free number above.