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Chronic Pain and Addiction: Two Peas in a Pod

Despite the cute title of this post, the story of how chronic pain and addiction interact is no fairy tale. Three factors of the healthcare situation in the United States contribute to the convergence of chronic pain and substance addiction. First, chronic pain has a significant impact on the quality of life and satisfaction, which makes it a significant risk factor for addiction. Second, prescription drugs and heavy pain medications are the primary forms of care for individuals with chronic pain. Finally, nearly a third of Americans suffer from some form of either acute or chronic pain. Given these factors, it is no surprise that chronic pain and addiction often go hand in hand, with the former heavily influencing the latter. Opioids, the primary form of pain medication in the United States, pose a particular problem for addiction. As one report on the issue states: “The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction.” In other words, chronic pain can lead indirectly to addiction problems through the use of pain medication and other forms of prescription drugs. Because managing pain usually requires heavy pain medication, chronic pain can be considered a risk factor for addiction. This discussion examines the what, how and what now?

Understanding Chronic Pain And the Risk of Addiction

With more than 30% of Americans suffering from chronic pain, it is no secret that the condition is associated with many adverse effects besides the bodily pain itself. With this level of pain, you may not be able to exercise, work or even enjoy a normal conversation without experience extreme discomfort. To treat this level of pain, most physicians prescribe pain medications that patients take for days, weeks, months and even years at a time. It is at this stage that pain medication can become truly addictive and can lead to some patients taking more than what was prescribed by their doctor. While pain medication does not lead to addiction in the majority of cases, it can be a dangerous area for many people, especially those who already have other risk factors for addiction.

Pain management often involves the use of potentially addictive pain medications. In fact, the most effective pain medications also come with the greatest risk for physical dependency and addiction.”

For this reason, those who have significant risk factors for or a history of addiction and addictive behaviors should be wary of prescribed pain medication. As noted above, opioid medications are the most obvious culprits and usual suspects of addiction to prescription drugs. Opioids are relatively common in terms of prescription medication, and include the following:

  • Hydrocodone (Vicodin)
  • Codeine
  • Propoxyphene (Darvon)
  • Oxycodone (OxyContin)
  • Fentanyl
  • Meperidine (Demerol)
  • Hydromorphone (Dilaudid)

You most likely recognize at least a few of those medications. Most people may not think twice if their doctor prescribed Vicodin or OxyContin, given their prevalence in the health care system. The addictive nature of the medication can lead some patients to start taking it for many of the same reasons that people take recreational drugs: to feel good, to feel better, and to do better. It is equally important to recognize how chronic pain and addiction interact in a clinical setting and that this interaction is unique to each individual. As one medical doctor states, “Similar to other chronic conditions such as diabetes, hypertension, or asthma, both pain and addictive disease often have biological as well as psychobehavioral contributors that may shape clinical expression. It will come as no surprise to learn that the convergence of pain and addiction can complicate recovery from both problems.” In other words, there is a reciprocal relationship between addiction and chronic pain. Chronic pain may require the use of addictive medication, addiction reduces the quality of life, reduced quality of life leads to further substance abuse…and the downward spiral continues. In this way, it is crucial to understand not only the interaction of chronic pain and addiction but also how to address it.

Recognizing Chronic Pain, Addiction, and How the Two Relate

Like addiction in general, addiction to prescription drugs and pain medication are often associated with various addictive behaviors that can be recognized both by yourself and those around you. You should talk to your doctor as well as an addiction counselor immediately about potential addiction if:

  • You find yourself craving drugs
  • You use your prescription drugs compulsively
  • You are unable to control your use of drugs
  • You continue using the drug even after the symptoms it was prescribed for has subsided
  • You continue to use the drug despite the mental, physical, social and even financial harm it has caused
  • You are taking more doses of the medication than prescribed
  • You are going to multiple doctors for multiple prescriptions
  • You find that the pain medication interferes with daily life
  • You feel symptoms of withdrawal with slowed use of the pain medication

Besides these symptoms, it is important to understand the difference between physical dependence and addiction. Pain medication (particularly of the opioid variety) nearly always leads to physical tolerance and dependence. However, physical dependence (and the symptoms associated with it) subsides within just a few days or weeks of the medication’s discontinuation. In contrast, addiction develops after months of exposure to the medication and represents an entirely different chronic condition. Because the effects are so long-lasting, there is a high risk of relapse in the years after coming off of the medication.

Moving Beyond Chronic Pain and Addiction: Where to Go From Here

The main takeaway from this discussion is that you should do everything you can to minimize the risk of addiction to prescription drugs and pain medication. One of the main strategies for minimizing this risk is to complete a self-assessment of addiction risk factors and addictive behaviors. Be honest with yourself – you are the primary line of defense when it comes to your health and wellbeing. Chronic pain is certainly hard to live with, but addiction is an entirely different beast altogether. If you are already on pain medication, consider taking the Addiction Quiz. It is often difficult to tell if you are truly addicted to drugs or other substances, and this resource should help you determine how to move forward after seeing the results. If you want to learn more about the interaction between chronic pain and addiction, you can also find a wide range of resources from the American Society of Addiction Medicine (ASAM) here.