How Do We Begin To Manage Pain Without Addiction Risk?
In the mid-1990’s, opioid painkillers started to become an accepted form of treatment to manage pain. In the last 20 years, however, these painkillers have been responsible for widespread addiction and overdoses, and have contributed to drug abuse, both prescription and illicit.
And the irony of it is, they are not only highly addictive, but can actually make chronic pain worse.
The growing awareness of opioid addiction has been in the news a lot lately – culminating with the death of the artist Prince, which appears to be a probable overdose of Percocet.
According to the Centers of Disease and Prevention, over 40 Americans die every day from prescription painkillers overdose. In 2014, the number of overdose deaths reached 29,000.
Of those, nearly 19,000 were from opioid painkillers. The other 10,500 were from heroin – a secondary drug of choice when painkillers are unavailable or too expensive to allocate.
What are Opioids?
Recognizable name brands for opioids are Vicodin, OxyContin, and Norco. They are all man-made versions of opium, which is found in certain types of poppy flowers. Purdue Pharma began campaigning heavily in the 1990’s for OxyContin, claimed it was less addictive than other painkillers.
Opioids connect to corresponding neurotransmitters in the brain, and result in reduced pain, improved mood, and possibly euphoria.
The Effort to Manage Pain
Around the time opioids started to become acceptable, there was a rash of complaints about health care providers and physicians under-treating pain.
Doctors began to ask patients to estimate their pain. This gave patients the capability of getting better pain medication. However, people started to use these drugs recreationally – they were given away to friends and family, sold, or stolen.
A January study published in the Annals of Internal Medicine revealed that among nearly 2,900 patients (May 2000 – December 2002) who had a non-fatal overdose during long-term opioid therapy, 91% continued to use opioids. Seventeen percent had another overdose within 2 years.
While many patients take their opioids as prescribed, they may have also encountered tolerance, which means they’ve had to increase doses in order to maintain the same level of pain relief.
At these doses, functioning may be impaired. And any substance use, such as alcohol or benzodiazepines, in addition to the medication makes them highly susceptible to overdose. This legitimacy of use can make addiction harder to recognize and treat.
Dependency itself can be debilitating, but when it’s still difficult to manage pain, as is common with long-term opioid therapy, it seems like the treatment may not be worth the effort.
Indeed, dependency can result in reduced daily function, memory impairment, sedation, and preoccupation with prescription drug availability.
Ways to Manage Pain Without Opioids
There are a wealth of non-opioid medications which may help with pain – at least worth a look at a first line of defense. These include over-the-counter medications such as acetaminophen, ibuprofen, and naproxen sodium.
For specific conditions, anti-spasmotics (muscle relaxers) and gabapentin (for nerve pain) are also options.
Additionally, pain clinics use occupational and physical therapy, acupuncture, exercise, and other alternative treatments. Yoga and chiropractic services may also help.
The CDC issued new guidelines recently which encourage doctors to avoid prescribing opioid painkillers for chronic pain, which is the most likely scenario for addiction to develop.
However, many patients are complaining that they are using the drugs responsibly for pain. And indeed, studies have found that most abusers of prescription painkillers do not actually have a prescription.
~ G. Nathalee Serrels, M.A., Psychology