Myths About Opiates and Addiction Affect Pain Management
You have the right to effective pain management. In fact, two years ago, the International Pain Summit in Montréal declared that it is a human right for all people to have access to pain management. In reality, many do not.
The Myths of Addiction and Pain Management
There is a myth in our society that taking painkillers means you're a bit of a wuss. We all understand that certain illnesses such as cancer can cause a great deal of pain and there is a great deal of support for terminal cancer patients getting the meds they need to deal with that. But non-cancer pain doesn't get the same kind of respect. In her recent post about opioid treatment for cancer and non-cancer pain, Karen Lee Richards speculates that this may be related to concerns about the risk of addiction. Concerns which thankfully now play less of a role in treating severe pain in people who are terminally ill. However, this brings me to the other myth in our society: that taking opioids for pain will automatically cause you to become addicted.
This is not true. Studies show that when opioids are prescribed and taken correctly, the rate of addiction can be as low as less than 1 percent. Despite the facts, the misperception persists that taking opioids cause addiction and should be avoided at all costs. Complicating matters is the lack of understanding that physical dependence on a medication is different than addiction. These misperceptions has led to a culture of suspicion where many in chronic pain are viewed as drug seekers and doctors who treat chronic pain are scrutinized and suspected of enabling addictions. The myths surrounding opioids are having a detrimental effect on the lives of people who live with chronic pain.
Harm Reduction and Addiction Treatment
Barry Lessin, a Pennsylvania addiction psychologist, says that he himself "had these judgments that are not true. They are ingrained in our cultural beliefs about addicts, causing them to become stigmatized. People internalize the stigma and undermedicate themselves." This has an impact on people who live with chronic pain, profoundly affecting their ability to function. In addition, for people who are in recovery, being undermedicated is the biggest risk for relapse. If the pain medication is not dealing adequately with pain, a relapse may not be so much about addiction, but about achieving the pain control you need.
Lessin recently challenged his own beliefs about addiction, which led to a change in the way he treats his patients. He now follows the Harm Reduction model of treatment, rather than the traditional rehab models, which he states are "unsuccessful because they don't start where people are. Instead they force people into a model of only doing things one way." Using harm reduction principles in the treatment of addiction "avoids the stigma and shame … and that puts the patient in charge of treatment. They identify what they need, not the doctor." He further explains that although approximately "5 percent will abuse, this can change if the person becomes aware of it." At the core of harm reduction is a "trust in yourself."
Getting Treatment for Your Pain
Access to pain management is a human right for everyone. If you are in recovery or currently addicted, it can be difficult to persuade your doctors that you are not "drug seeking," but merely trying to get effective pain control. One factor that can complicate getting appropriate pain management is that people who have chronic pain often see multiple doctors. Lessin recommends "developing a collaborative relationship with your doctors" and to ask that they in turn collaborate with each other. Nurturing the self advocacy skills required to have these kinds of conversations with doctors can take some time, but will help you get better treatment.
If you're concerned about the possibility of becoming addicted or relapsing due to your pain management needs, talk to your doctor about these issues. You may also want to seek out the services of a counselor, social worker or addiction psychiatrist who can help ensure that you get the treatment you need for your pain while protecting you against addiction or relapse.
Pain is the author of the award-winning blog The Seated View.