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.
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.
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