Sunday August 28th 2016

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Getting rid of chronic pain without risking addiction

By Dr. Alkesh Patel, MD

We have a chronic pain problem in America, and we need to fix it. Yet, the medications we once thought were helpful have proven dangerous to a large population, often resulting in addiction. We need to find different ways to address our chronic pain epidemic and move away from our reliance on painkillers.

How can you avoid addiction to painkillers? While we all have different tolerance levels for pain, the use of narcotic pain killers is not your only option for relieving pain (there are alternative treatments). We explore here. Then, we invite your questions or comments about coping with chronic pain in the comments section at the end.

What Does Chronic Pain Look Like?

The experience of pain is direct, upfront, and personal. The International Association for the study of Pain defines it as:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”

Chronic pain means your pain is associated with a chronic medical condition or lasts longer than six months.

How We Became Addicted to Painkillers as a Nation

Over the past two decades, there has been wild growth in the sales and prescribing of opioid painkillers. As a matter of fact, in 2011, hydrocodone topped the list of most prescribed painkiller with 136.7 million prescriptions filled in the U.S. However, a significant linear relationship exists between sales of opioid pain killers (fentanyl, hydrocodone, hydromorphone, morphine, oxycodone) and deaths related to using these medications.

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Factors fueling an increase in painkiller prescriptions include:

  • aggressive marketing by the pharmaceutical industry
  • the promotion of painkillers by physician groups and other private organizations to address chronic pain
  • a lack of understanding and education surrounding pain management and addiction
  • lax laws governing the prescribing of opioids over the last two decades

These developments alongside the notion that pain is undertreated – and the assumption that opioids are relatively safe and effective medications for treating chronic pain – helped further the painkiller epidemic we have today.

How Painkillers Work

Opioid painkillers act by attaching to specific receptors which are found in the brain, spinal cord, and other organs in the body. When these drugs attach to these receptors, they reduce the perception of pain. Opioid painkillers can also cause a euphoric response in certain patients, possibly activating the pathway to painkiller misuse and addiction.

How to Avoid Painkiller Addiction

In order to reduce the risk of painkiller addiction, especially if being considering for a trial of painkillers for chronic pain, a doctor should take certain precautions. There are several steps that can be taken to reduce the risk of addiction while addressing a chronic pain complaint. These include:

1. Take a careful history and screen for possible risk factors that may increase a person’s chance of misusing or becoming addicted to painkillers. These include a current or previous personal history of addiction, and family history of addiction.

2. Performing a thorough physical and neurological exam, obtaining a careful family history can be helpful when identifying the exact cause and type of chronic pain. Depending on the cause of the pain, an appropriate medication or behavioral approach can be recommended. It’s important to realize that opioid pain medications will not effectively treat all types of pain, and that there is a risk of long term side effects.

3. Doctors should also note depression, anxiety, and other mental health issues, which have not yet been addressed. These psychological conditions could increase the risk of misusing painkillers to cope with stress or to otherwise self-medicate.

The Other Painkillers and Alternatives to Painkiller Medication

OPTION 1: OTHER TYPES OF MEDICATIONS

There are many pain medications available that are not addictive. What are your options?

  • Anti-inflammatory medications
  • Anticonvulsant medications
  • Antidepressant medications

All can be used to treat chronic pain. It’s important for individuals to review the potential risks and benefits of each treatment with their doctors. Antidepressants and anticonvulsants carry less abuse potential than traditional opioid painkillers and can be used to treat different issues that can accompany chronic pain, such as:

  • anxiety
  • depression
  • other pain conditions such as migraines, fibromyalgia, and muscle spasms

OPTION 2: LIFESTYLE CHANGES

Exercise, appropriate diet, physical therapy, acupuncture, psychotherapy, hypnosis, meditation, and other behavioral approaches have also helped patients address chronic pain. They can be combined with medications or utilized entirely on their own.

Honesty is key to moving forward

Working with health care providers, being forthcoming and honest about a chronic pain complaint as well as documenting appropriate improvements or setbacks in addressing chronic pain will be important for patients who want to improve quality of life – and their chances of getting better.

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About the Author: Dr. Alkesh Patel is triple-boarded in General Psychiatry, Addiction Psychiatry and Addiction Medicine.  He completed his addiction training and worked at Mount Sinai Medical Center in New York as the Associate Director of Addiction Psychiatry Fellowship Training Program before joining Mountainside Treatment Center.  At Mountainside, Dr. Patel provides medication management to clients in all levels of care including clients with dual diagnoses.

Leave a Reply

One Response to “Getting rid of chronic pain without risking addiction
Janjan
11:19 pm February 26th, 2016

After 5 years of unremitting unexplained coccyx pain I finally was prescribed slow release tramadol from my pain management consultant.Within 2 days the level of pain reduced from a 5 and 6 to sometimes 2 and for short periods of time, no pain at all.it was wonderful and after 6 months of 100mgs b.d I hoped I could reduce and then stop it altogether.But of course, persistant pain doesnt work that way and I was as before.No choice but to go back to the opiate.I also am on duloxetene and pregabalin and have had extensive treatment with CBT, EFT, mindfulness, acupuncture, stress reduction, hypnotherapy caudal injections etc etc blah blah blah.i have no choice left but to accept and adapt to a mean pain that flares up then calms a bit for the rest of my life.
So, to get to my point of writing this, Dr Patel, I feel that to have the quality of life that keeps me reasonably well, I should stay on my present medication to which I am now dependent.Does that make me addicted to it?.What is the difference between the two.? Will there come a time when my present dose is not enough (I am starting to get regular increasing pain levels)What do I do then? Any general practitioner I see tell me I am on “a lot of drugs”.I KNOW THAT
ALREADY.There seems to be an underlying reluctance in general practice to deal aggressively with chronic pain.Well, I am quite happy to let them experience it and see how they feel!I am also scared for the future as I get older and as I am already becoming lame due to arthritis left knee and have the added pleasure of the pain that goes with that too.Maybe if I had ever been given a medical reason for my tail pain I might feel better cos I sometimes think they neither believe me or think I can use these drugs responsibly.I do and I can.
Perhaps you might comment on life long opiates.I am 60 year old female.thank you

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