Chronic Pain and Substance Abuse – A Challenging Combination

woman with chronic pain on hospital bed

Chronic pain can lead to addiction

Chronic pain has a profound effect on anyone’s life. If you’re saddled with chronic pain, you may not be able to work or exercise, let alone enjoy life in general. Pain causes sleep disturbances and, when chronic, often triggers symptoms of depression. In short, life with chronic pain can be miserable. It’s no surprise that it can also spark substance abuse in some individuals in a desperate attempt to alleviate it.  And for those who already struggle with addiction or have a history of drug rehab treatment, treating the pain with medications – which often have a high potential for dependence – becomes a complicated endeavor.

Substance Abuse — Pain Connection

Up to 50 million Americans live with chronic pain at any given time. Coping with it can be so challenging that reaching for alcohol and / or drugs becomes a tempting quick fix. Getting drunk or high provides at least a temporary way to alleviate the intense discomfort and deal with the stress it causes.  However, while substance abuse can seem to initially provide relief, it inevitably makes things worse.

Substance abuse disrupts natural sleep patterns and can cause or worsen symptoms of depression. It also creates additional stress. An alcohol or drug addiction can lead to job termination, derail a career, and make it impossible to find a job at all. It interferes with one’s ability to take care of a family, and also makes it difficult for addicts to care for themselves.  The latter can be especially worrisome in a chronic pain patient who may need to take medication or undergo other types of treatment.  More stress leads to more self-medication and an already vicious cycle becomes even more vicious.

Chronic pain treatment in and of itself also sometimes contributes to the development of addiction and the subsequent need for drug rehab treatment. When medications, such as opioids (like Oxycodone) or benzodiazepines (like Xanax), are properly prescribed and used, the chance for addiction is relatively low, although it can still occur.  Although individuals with a history of substance abuse or addiction tend to be more vulnerable, even those without previous substance problems are still at risk.  This is because it’s so easy to exceed the prescribed dose when grasping for relief.  The belief that “more is better” gets many chronic pain patients in trouble down the road.

Substance Abuse Treatment

Substance abuse and chronic pain require specialized treatment that focuses on both the body and the mind. It’s best to find an addiction facility that is skilled at working with patients struggling with both conditions. An integrated program helps patients manage their pain while reducing the risk of relapse.

Psychotherapy is often a major component of treatment. During therapy, patients learn to identify the factors that play a role in their substance abuse, as well as those that might contribute to chronic pain.  They learn to think differently about negative emotions and problems, and are taught ways to cope with them without relying on substances.

Pain Management Options

Substance abuse presents challenges to the management of chronic pain. Any person in pain deserves relief. However, physicians have often struggled with balancing the need for pain management with the desire to prevent addiction or relapse. In some cases, the concern has compelled some primary care physicians to avoid treating chronic pain patients altogether. There are options, however, that should be considered and explored to minimize the risks.

Non-Addicting Drugs for Pain Relief

There is a range of non-addicting pain management medications available today.  For example, some types of antidepressants, anti-epileptic, or anti-arrhythmic drugs may be used to reduce pain. Like other drugs, these medications have side effects, but they are non-addictive and can be effective in providing needed relief.

Non-Drug Pain Management

Other therapies that manage pain don’t involve medications. Mind-body therapies are a very good option, because they work by using one’s mind to control physical symptoms. Common strategies include meditation and biofeedback. Chiropractic treatment is another non-surgical, non-drug method.  Making sure the spine is in proper alignment can help reduce back and neck pain. Acupuncture is another non-drug pain management approach, utilizing techniques that help release endorphins.  These brain chemicals work as natural pain relievers.

Prescription Opioids

Opioid drugs, such as Vicodin and OxyContin, are often prescribed for pain relief.  But, these drugs are easily abused and can lead to dependence.  Research has found that pain patients who were taking opioid pain relievers were more likely to steal prescriptions if they had a history of addiction. Because of the risk, most physicians will only suggest these medications for a current or recovering substance abuser when necessary and appropriate. This is often done only if the patient is receiving ongoing drug rehab treatment counseling.

One strategy to reduce the risk of addiction is called an opioid agreement.  Such an agreement outlines the responsibilities of both the patient and the physician. These voluntary contracts may include a promise to return any unused medication to the physician and / or to have a third party, such as a family member, dispense the drugs as needed. An agreement may also require the patient to use a single, agreed-upon pharmacy for fulfillment and submit to periodic drug tests.

Some patients with a substance abuse history can safely take opioids to reduce pain, particularly if they have a well-defined treatment plan that addresses the potential for abuse. In one study done in a Veterans Affairs facility, physicians used a combination of opioid agreements, close consultation with pharmacists, limited medication supplies, and more frequent office visits. Of the patients who received this treatment, 45% were able to manage pain without incident.

Researchers and drug rehab treatment professionals are also hopeful about a new drug combination that appears to reduce the risk of addiction in those taking pain medications. Scientists in Australia and Colorado have teamed up to examine the potential of a drug called (+)-naloxone. A similar version of it is already used to treat opiate overdoses. They believe that (+)-naloxone can boost the pain-relieving qualities of opioid drugs while blocking some of their addictive effects. The research is still in the early stages, but it’s a good indication that the scientific community is continuing to search for ways to reduce addiction to pain-relieving drugs.

If you or someone you love struggles with chronic pain and substance abuse, there is hope. Alcohol and drug rehab treatment counselors can work with your pain management specialist.  Together, they will create a plan that addresses both issues effectively so that you’re able to live a more normal life.

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