My friend T. lives with high levels of chronic pain. The pain makes it difficult to get through each day and it's not just having an impact on his physical function, but on his relationships with his family and friends, as well. Despite this, he's not taking any pain medication. T. was an alcoholic and has been sober for nine years. He's afraid that if he starts treating his pain, he might relapse and start drinking again.
Those of us who live with high levels of chronic pain are often faced with concerns about addiction to painkillers. Sometimes it's our family and friends who get worried and sometimes it's our doctors. The goal of managing chronic pain is to "obtain reasonable pain relief while maintaining a maximum level of function" (Prater, Zylstra and Miller, 2002). At HealthCentral, we do our best to help you get that kind of pain control by giving you the tools you need to counter concerns about addiction. The fact is that the risks are generally quite low. But what if you are in recovery from addiction or are still struggling with it? How can this impact treatment for your pain?
Pain Management is a Human Right
Five to seventeen percent of the population in the US live with the challenges of substance abuse. This group is less likely to receive adequate pain control. One factor contributing to this is that doctors may be afraid of triggering an addiction but ironically, undertreatment carries a risk of relapse. When the medications do not adequately address the pain, you may be more likely to self-medicate with alcohol, other people's painkillers or seeking help in illegal drugs. Getting proper pain control can actually protect you against a relapse.
In 2010, the delegates at the International Pain Summit in MontrÃ©al passed a declaration stating that it is a human right "of all people to have access to pain management without discrimination." Human rights are not negotiable, they are not granted with a caveat stating "but not in the case of..." If you are struggling with addiction or in recovery, you have as much right to have pain treated as someone who has never experienced addiction.
You have a range of options for treating your pain, both in medication and other treatments. Be honest with your doctor and make sure they know if you are presently addicted or in recovery. The more they know about your situation, the better they'll be able to tailor the treatment to protect you. If they're nervous about treating you due to concerns about addiction, do your research and bring in documents that support your right to treatment. That can include this post, the resources I've linked to or the references at the end of the post.
There are a number of painkillers that do not have the potential for addiction. NSAIDs and, the COX-2 inhibitor Celebrex can be very useful in controlling mild and moderate pain. As well, medications for nerve pain, anticonvulsants or certain muscle relaxant such as Lyrica and gabapentin can also be valuable tools in fighting pain.
Other types of treatment can also be an important part of managing pain. In fact, effective pain management often includes more than just medication. For instance, physical therapy can help strengthen your muscles, thereby making movement easier on your body. A physical therapist can also help you by using ultrasound, paraffin baths and TENS. Acupuncture, biofeedback, meditation and yoga may also help chip away at the pain and help you function better. Talk to your doctor about getting a referral to a pain management specialist who uses a multidisciplinary approach in their practice. If you can't find is a specialist in your area, try accessing some of the suggestions in this post through your family doctor (e.g., referral to physical therapy) and look in the Yellow Pages or online for licensed acupuncturists and pain or stress management classes that use mindfulness training.
Sometimes, there's nothing for it. Sometimes, the pain is so severe that you need opioids. When you do, you might have a higher risk of becoming addicted to painkillers than those who have not experienced substance abuse. To manage the potential for a relapse you and your doctor need to create a structure around how you get the medication and how you take it.
A treatment agreement can be an essential part of this. Such an agreement outlines the process that will be used to prescribe and take the medication and protect against addiction. It can include getting your prescriptions from just one doctor, filling prescriptions from one pharmacy only, taking meds on a schedule rather than as needed and taking regular drug tests.
You and your doctor also need to make smart choices about the opioids that are used. Longer-acting narcotics can be a better choice because they reduce the amount of times you take the meds. Certain opioids may have a higher risk of addiction and others may have a built-in process that protects from addiction. For instance, Suboxone, a drug that can be used to wean off opioids, can also be useful for treating pain safely. This drug blocks other opioids from being effective and also blocks itself from causing an overdose. However, keep in mind that these suggestions are merely ideas for you to discuss with your doctor - every person's pain is different and what is appropriate for you may be something else entirely.
You should also be aware that being an addict can mean that you might have a tolerance to narcotics and therefore possibly need larger doses of medication to get effective pain control. As mentioned above, if your pain is not adequately controlled, you may feel the need to self-medicate, thereby triggering a relapse.
When you use opioids for your pain, make sure you involve your support network in helping you stay straight while you're being treated. This can include your family and friends, going to regular AA or NA meetings and finding an addiction counselor.
At the end of the day, remember that you have a right to get your pain treated. Your experience with addiction does not negate that right, but it can mean that you need to be extra careful when considering what kind of treatment to use. There is help out there. You don't have to live in uncontrolled pain.
Ziegler, Penelope P. "Addiction and the Treatment of Pain." Substance Use & Misuse, 40:1945-1954.
Prater, Christopher D, Zylstra, Robert G. and Miller, Karl E. "Successful Pain Management for the Recovering Addicted Patient." Primary Care Companion Journal of Psychiatry. 2002; 4(4). 125-131
Lene is the author of the award-winning blog The Seated View.