Pain Management and Opioid Addiction
What Is Opioid Addiction?
Opioid use disorder is a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress. It often includes a strong desire to use opioids, increased tolerance to opioids, and withdrawal syndrome when opioids are abruptly discontinued. Addiction and dependence are components of a substance use disorder and addiction represents the most severe form of the disorder. Opioid dependence can manifest as physical dependence, psychological dependence, or both.
Opioids include substances such as morphine, heroin, codeine and oxycodone. These can be bought illegally or prescribed. The diagnosis of opioid use disorder is often based on criteria by the American Psychiatric Association in the DSM-5. These include a preoccupation with a desire to obtain and take opioids, as well as using more than intended despite social and professional consequences due to these behaviors.
Dealing with Sudden Grief after an Opioid Overdose
What Is Chronic Pain?
Chronic pain is any pain that lasts for more than three months (approximately 90 days). The pain can become progressively worse and reoccur intermittently, outlasting the usual healing process. It can occur in a variety of places within the body. Unlike acute pain, which is short term, chronic pain is long-lasting and may show up as headaches, back pain, arthritis and/or muscle pain.
What Causes Chronic Pain?
Chronic pain has many different causes. It can be a result of nerve damage or injuries that refuse to heal. It can also come from normal aging conditions within the bones and joints. Sometimes chronic pain develops from disease or birth defects. There are even cases with no known cause for the pain at all.
Many times, chronic pain is complex and caused by a variety of factors. For example, back pain may be from a number of things such as years of improper posture, improper lifting of heavy objects, and being overweight. While none of these things singularly create the pain, the combination of them all can lead to persistent chronic pain.
Opioids and Chronic Pain
Because of its complex nature, treating chronic pain can be difficult. There are multiple options to explore including medication and therapy. However, doctors for most of the twentieth century stayed away from writing prescriptions for opioids because of concerns for addiction, increased disability and lack of effectiveness over time. Around 1990, due to a variety of medical and non medical factors, the perception about opioids began to change. Since that time, the use of opioids to treat chronic pain has continued to increase. It is estimated that over 2 million people in the US struggled with an opioid use disorder in 2016.
Opioids can be effective in treating chronic pain. However, with prolonged use the user becomes both more tolerant to its effects and more physically dependent on the drug. This can happen after only a couple of uses for some, while others may develop this addiction over time. For many struggling with chronic pain, the cycle of addiction starts here.
There is also a condition called hyperalgesia, often induced by opioids. This condition is a “catch-22” where the patient receiving opioid treatment for pain actually develops an increased sensitivity to pain. In other words, the opioids themselves may cause the patient to think the pain is worse than it is, and thus feel they need more medication.
Opioids and Addiction
Initially, many people who struggled with opioid use disorder will attempt to hide it by seeking prescriptions from multiple doctors. Today doctors and medical professionals are more aware of the potential addiction with these prescriptions. Tamper-resistant pills have also been introduced, which limits the access to pain pills. This leaves the people struggling with addiction to turn to street drugs, such as heroin.
Opiate use disorder begins with the patient taking more than the prescribed dosage or taking it more frequently than indicated. Detecting this abuse early on can be highly effective in getting help prior to addiction.
There are signs that can indicate if a person is struggling with addiction. They include:
- Hiding drug or alcohol use
- Taking multiple prescriptions from multiple places
- Lying and cheating loved ones
- Sudden mood swings and short tempers
- Legal problems
- Withdrawing from social activities they once enjoyed
- Impulsive actions and decision making
- Itchy skin
- Needle marks, dry mouth, blurred vision, skin blotches etc
- Complaints of severe confusion, mania, hallucinations, etc
Is an intervention necessary?
If you are concerned about a loved one struggling with an opioid use disorder, there is help. It can be difficult to reach out to a loved one who has grown withdrawn and isolated. Yet, with the help of an experienced interventionist there is hope.
Interventions can and do work. An interventionist will lead the process, allowing the identified individual to always feel supported and loved, while addressing that there is a serious issue.
An interventionist can identify new solutions to health problems, mental health disorders and chronic pain. They can also identify new ways of living and a path for recovery. The family will also learn more about addiction and codependency, which brings healthier relationships significant changes to their own healing process.
Articles About Opioid Addiction & Chronic Pain
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PIVOTS – What do Kevin Durant, Stephen Curry, LeBron James, Chris Paul, Kawhi Leonard and I have in Common?
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In Andrew Sullivan’s sprawling New York Magazine take on the voracious nature of the opioid crisis - “The Poison We Pick” - he posits that the “drugs now conquering America are downers: They are not the means to engage in life more vividly but to seek a respite from...read more
Podcast: How To Heal After A Sudden Loss From An Addiction Related Death There were more drug-related deaths in 2016 than from the entire Vietnam war or the HIV/Aids epidemic at its height - and for every person who died suddenly and tragically there are at least four...read more
As a licensed clinical social worker, family interventionist and an addiction expert, I’m always on the hunt for research, advice and news from other healthcare experts. As such, I recently read an outstanding column by a practicing anesthesiologist that sheds new...read more
Additional Resources on Pain Management & Opioid Addiction
Podcast: How To Cope With Chronic Pain
Many More People Seek Medical Help For Opioid Abuse — on NPR.org
Treating pain without feeding addiction: Study shows promise of non-drug pain management – on ScienceDaily.com
The Other Tragedy Behind Prince’s Death — on CNN.com
USDA chief Tom Vilsack targets rural opioid problem — on KnoxNews.com
How Bad is the Opioid Epidemic? — on PBS.org
Why the Pain Drug That Killed Prince Can Be Especially Dangerous — on ScientificAmerican.com
This is a great PDF from Scientific American called It’s Chemistry, Not Character