Chronic Pain and Addiction: What’s the Connection?
Everyone knows what pain is. All of us (aside from a few questionable individuals) do not like it and would do just about anything to make it stop. Most of the pain we experience, like stubbing a toe or stepping on a Lego, is acute and disappears in a few moments or days. Chronic pain, however, can spring up anywhere in the body and can last for months or even years. Can you even imagine?
The good news is that there are many treatments for helping people deal with pain, whether acute or chronic. The downside is that most medications used to treat chronic pain contain qualities that can make them addictive and build dependencies.
Below is a factual guide about chronic pain, addiction, and where to look for help if you or a loved one has succumbed to the caresses of prescription opioids.
Acute vs. Chronic Pain: What’s the Difference?
Acute pain and chronic pain differ in their duration, causes, and treatment. Acute pain is sudden and intense, normally caused by physical injuries or infections. It generally lasts for a short time (from a few minutes to a few weeks) and goes away when the underlying cause is treated. Chronic pain is tenacious and lasts for longer than 90 days, sometimes even after the original injury or illness has recovered.
Acute pain is typically treated with medications, such as analgesics or anti-inflammatories, or with non-pharmacological methods, such as ice packs or massage. Chronic pain might require a cocktail of medications, physical therapy, psychological counseling, or alternative therapies, such as acupuncture or meditation.
What Causes Chronic Pain?
Chronic pain is a severe pain that is felt for more than three months, can affect any part of the body, and causes various sensations, such as aching, burning, throbbing, or tingling.
Nerve damage is one of the main causes of chronic pain. This happens when the nerves or other parts of the nervous system are diseased or injured, and it makes the pain signals more intense and long-lasting.
Psychological factors, such as stress, anxiety, and depression are other causes of chronic pain. These factors can affect the brain’s processing of pain signals and increase the severity or persistence of the pain. Some people may experience chronic pain without any apparent physical cause in a condition known as psychogenic pain or psychosomatic pain. Other common causes of chronic pain include arthritis, migraines, endometriosis, and cancer.
Signs and Symptoms of Chronic Pain
Chronic pain is pain that lasts longer than three months, even after the original cause of the pain has healed or is unknown. Chronic pain can be identified by various physical and emotional symptoms, such as:
- Constant or intermittent pain that ranges from mild to severe.
- Pain can be felt in different parts of the body, such as the joints, organs, nerves, or muscles.
- Pain that can be described as burning, aching, stabbing, throbbing, or tingling.
- Fatigue, insomnia, and loss of stamina and flexibility.
- Depression, anxiety, irritability, and mood swings.
- Problems concentrating, working, socializing, and enjoying hobbies.
The Psychological Effects of Chronic Pain
The psychological effects of chronic pain are complex and can vary from person to person. Some psychological effects include:
- Stress. Chronic pain can trigger the body’s stress response, and this can increase the levels of hormones such as cortisol and adrenaline, which affect the immune system, blood pressure, heart rate, and blood sugar.
- Depression. Chronic pain can induce feelings of sadness, hopelessness, guilt, and worthlessness. Depression can affect the motivation to seek treatment, adhere to medication, and engage in self-care activities.
- Anxiety. Chronic pain can increase feelings of fear, worry, nervousness, and panic. Anxiety can make the pain more intense and difficult to cope with while interfering with sleep quality and increasing the risk of developing insomnia.
- Substance abuse. Chronic pain can lead some people to turn to alcohol or drugs to cope with their pain. This can lead to substance abuse and alcohol misuse, which have negative effects on physical and mental health.
- Isolation. Chronic pain can make it difficult to participate in social activities or hobbies that previously brought joy and satisfaction and can also lead others to misunderstand or judge a person’s condition or behavior.
Commonly Abused Pain Medications
Opioids, most of which are derived from the opium poppy plant, are some of the most commonly abused pain medications. Some examples of opioids are.
- Fentanyl: This is a synthetic opioid that is 50 to 100 times more potent than morphine. Fentanyl is used to treat severe post-surgery pain or with cancer patients.
- OxyContin: This brand name for oxycodone is a semi-synthetic opioid that is derived from thebaine, a chemical found in opium. It is used for treating moderate to severe pain that lasts longer than a few days.
- Demerol: A brand name for meperidine, this is a synthetic opioid similar to morphine. It is used for treating moderate to severe pain that occurs suddenly or before and during surgical operations.
- Hydrocodone: This is a semi-synthetic opioid derived from codeine, another chemical found in opium. Hydrocodone is used for treating pain that does not respond to other treatments. It is usually combined with other medications, such as acetaminophen (Tylenol) or ibuprofen (Advil), to reduce its side effects and enhance its effectiveness.
- Morphine: This is a natural opioid extracted from the opium poppy plant used to treat severe post-surgery pain or pain from cancer.
- Percocet: A brand name for the combination of oxycodone and acetaminophen, it’s used for treating pain from injury or disease.
How is Chronic Pain Connected to Addiction?
Chronic pain and its associated syndromes are complicated and notoriously difficult to treat. Most people require a combination of medications that address different aspects of a pain syndrome.
Complicating matters even further is the highly addictive nature of most prescription-level pain medications Opioids like Percocet, OxyContin, and Vicodin flood the brain with the “feel-good” chemical, dopamine. Over time a condition called opioid-induced hyperalgesia develops which is where the same medications that deliver relief can lead to additional pain.
Opioids belong to the same class of drugs as heroin, and people with chronic pain who can’t get a higher dose of prescription opioids through their providers resort to using heroin. Alarmingly, according to the National Institutes of Health (NIH), approximately 80% of the Americans who use heroin started by first abusing prescription opioids.
Why Are Opioids Used for Pain Management?
Opioids act directly on the brain’s control centers for pain and euphoria. They block the transmission of pain signals from the nerves to the brain and induce a very relaxed and joyful state. Opioids can reduce moderate to severe pain that may not respond well to OTC medications. This makes opioids very effective at dealing with chronic pain.
How Chronic Pain Leads to Addiction Issues
Chronic pain is recognized as one of the gateways to substance use disorders. This ongoing and debilitating condition cannot just be ignored or “walked off”. It calls for medical intervention. Chronic pain can lead to addiction issues in several ways.
- Chronic pain may cause physical and emotional distress, such as reduced mobility, insomnia, anxiety, and depression. Some people turn to alcohol or drugs to cope with their pain or emotional problems, and this can lead to dependence and addiction.
- Chronic pain can require using prescription painkillers (such as opioids) which are highly addictive. Opioids effectively cancel out pain, but they can come with side effects, such as nausea, constipation, drowsiness, confusion, and respiratory depression. Misusing opioids can also lead to the development of the addiction cycle (tolerance, dependence, addiction, and withdrawal symptoms).
- Chronic pain can negatively affect daily activities and social relationships. This condition can lead someone to self-isolate, shun their usual hobbies and interests, and experience stigma or discrimination. These factors can affect one’s self-esteem and well-being and make one more susceptive to addiction.
Side Effects of Opioids
Opioids are effective at treating various types of pain, but they also come with side effects, some of which can be serious or even life-threatening.
Some of the common side effects of opioids are:
- Nausea and vomiting: Opioids can affect the digestive system and cause stomach upset, loss of appetite, and vomiting which can lead to dehydration and malnutrition.
- Constipation: Opioids can slow down the movement of food and waste through the intestines and cause hard stools, difficulty passing stools, and abdominal pain. This can lead to hemorrhoids, anal fissures, and bowel obstruction.
- Drowsiness and dizziness: Opioids effect on the central nervous system (CNS) can cause sleepiness, fatigue, and impaired coordination, which increases the risk of falls, accidents, or injuries.
- Dry mouth: Opioids affect saliva production and cause dryness in the mouth.
- Itching: Opioids may trigger histamine (a chemical that causes allergic reactions) release, which can cause itching, redness, or skin rashes.
- Mental fog: Opioids can affect cognitive functions and cause confusion, memory loss, difficulty concentrating, or hallucinations.
Opioids are powerful drugs that should be used for short periods and only as prescribed by a doctor.
What are the Problems With Pain Management and Addiction?
The root problem with pain management and addiction is that many people who suffer from chronic pain rely on opioids for pain relief, but opioids can also cause dependence, tolerance, and addiction. Opioids work by blocking the pain signals from reaching the brain while inducing feelings of satisfaction and euphoria.
Most people who take prescription opioids for pain management have no intentions of developing addictions, but they may end up misusing their medication or hunting other sources of opioids, such as illegal drugs or online pharmacies, which increases the risk of overdose and death. The Centers for Disease Control and Prevention (CDC) records for 2019 show that nearly 50,000 people died from opioid overdose in the United States alone.
Various factors that contribute to the problem of pain management and addiction are:
- Scarcity of alternative pain treatments, such as physical therapy, acupuncture, massage therapy, or psychological counseling.
- Absence of awareness and education about the risks and benefits of opioids among patients and health care providers.
- Shortage monitoring and regulation of opioid prescribing and dispensing practices.
- Insufficient support and resources for people who struggle with chronic pain and addiction.
This is a complex and challenging issue that requires a holistic approach that addresses both the psychological and physical aspects of pain and addiction.
Chronic pain is a complex and challenging condition that affects many people and requires adequate and safe pain management. Some physicians harbor misconceptions about chronic pain and its treatments (like opioids) that hinder optimal care. Some of these misconceptions are:
- Chronic pain comes naturally from aging and cannot be treated.
- Chronic pain patients who abuse substances are exaggerating their pain.
- Chronic pain patients who regularly use opioids will inevitably become addicted.
- Chronic pain patients who exhibit deviant behaviors, like seeking more opioids or reducing their use, have an opioid use disorder (OUD).
- Chronic pain patients with an OUD cannot benefit from alternative treatments, like physical therapy, acupuncture, or psychological counseling.
These misconceptions can lead to inappropriate treatment of chronic pain and addiction. Holistic treatment methods become ever more important for physicians when treating chronic pain and addiction.
Adhering to the following protocols can help reduce the risk of developing addictions to pain medications.
- Store Opioids Properly
- Do not exceed the prescription amounts.
- Alert your doctor about any side effects or concerns you may have about using opioids.
- Avoid mixing opioids with alcohol and other substances or medications. Never mix opioids with other drugs, especially those that cause drowsiness, such as:
- Benzodiazepines (such as Xanax® and Valium®)
- Muscle relaxants (such as Soma® or Flexeril®)
- Sleep aids (such as Ambien® or Lunesta®)
- Other prescription opioids
- Never share or sell your prescription opioids.
- Properly dispose of unused prescription opioids at the end of your treatment.
Alternative Treatments for Pain Management
Alternative treatments for pain management are non-surgical, non-narcotic methods that can tackle chronic pain and improve quality of life. Some common alternative treatments for pain management are.
- This traditional Chinese medicine technique involves inserting thin needles into precise points on the skin to stimulate the flow of energy and balance the body. This can help with different types of pain, such as fibromyalgia, osteoarthritis, back pain, and headaches.
- Mind-body therapies. These treatments include relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis to influence the mind and relax the body. Mind-body therapies help people cope with stress, anxiety, depression, and anger that can aggravate their pain.
- Physical therapy. This treatment uses exercises and proven- techniques to strengthen muscles, improve posture, increase mobility, and reduce stress on the affected areas. Physical therapy helps people with pain derived from injuries, surgeries, or diseases, such as spinal stenosis, arthritis, or sciatica.
- Massage therapy. This treatment employs manual manipulation of soft tissues, such as muscles, tendons, and ligaments, to improve blood circulation, reduce inflammation, and relieve tension. Massage therapy helps people with pain caused by muscle spasms, knots, or trigger points.
- Chiropractic treatment. This remedy uses spinal manipulation or adjustment to correct the alignment of the spine and improve the nervous system’s functioning. Chiropractic treatment can help people with pain induced by nerve irritation or compression, such as back pain, neck pain, or sciatica.
Other alternatives for pain management treatments may include herbal remedies, dietary approaches, yoga, reiki, aromatherapy, and more, though not all alternative treatments are proven to be effective or safe for everyone. Consult with a doctor before trying any alternative pain management treatment and follow their instructions.
Chronic Pain and Addiction Treatment at Luna Recovery
Addiction is nothing to be ashamed of, and there is help available to overcome it. Luna Recovery is a treatment facility that specializes in helping people overcome drug and alcohol dependencies and addictions. Our forward-thinking and unique approaches to recovery treatment ensure that you or your loved one will be supervised by a caring staff and supported by a community of your peers along your journey.
There is no reason to not take the first step toward a healthy life right now. Contact us today to enquire about your available treatment options, enroll in a program, or schedule a tour of our facilities to see whether we are the perfect fit for you.
Dr. Allaire received his Bachelors of Science in Biology from the University of Houston, as Valedictorian of the College of Natural Sciences and Mathematics, and his Medical Doctorate from Baylor College of Medicine, where he served as Chief Resident. He is the medical monitor for the Physician Counseling Committee of the Harris County Medical Society and the Medical Director of Serenity House Detox. Dr. Allaire specializes in medically assisted detox cases, treating patients in recovery from addiction or other mental health disorders, the medical assessment and monitoring of patients with addictive disorders, medical care related to eating disorders and the medical treatment of patients with mental health conditions.