In the journal Anesthesia and Analgesia, the authors write that pain management should be considered a “fundamental human right.” People who have severe and immediate pain concerns, such as patients with broken bones and deep cuts, need proper medications, but people with chronic pain from back injuries or cancer also need adequate pain control. Where in the past it might have been considered a nicety provided to people because doctors were compassionate, now pain management is seen as something that all people, at all stages of life, have a right to demand.
There are some people who are worried about this concept. People who are in recovery from addictions to painkillers, opiates, alcohol or drugs might not want to take medications for pain control, as they believe that even one taste of drugs could awaken their sleeping addictions and cause a relapse. In addition, some people don’t want to take pain medications as they worry they will develop an addiction issue. Perhaps avoiding the medications will help them stay safe.
At Michael’s House, we understand these concerns. We’ve seen many people put years of hard work into recovery, and we know that this isn’t an accomplishment to be taken lightly. But, we also know that there are ways that pain management can be a part of an addiction recovery and maintenance plan. Read on to find out more.
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Medications used for pain are powerful, and they can be addictive. But, that addiction rarely comes on quickly, the first time that someone uses the drugs. Instead, addiction tends to develop slowly, moving through several phases. And, some people who use prescription painkillers never become addicted at all. Understanding the terms medical practitioners use to describe this continuum might be helpful.
A person who uses prescription painkillers floods the body with a specific type of chemical, and the body adjusts its own chemical makeup in response. The body doesn’t like to be overwhelmed in this manner, and it doesn’t like to have pain signals ignored, so it will try to keep the body in balance by reacting less and less dramatically each time the person takes the drug. Soon, a tolerance for the drug develops. Smaller doses of the drug don’t seem to do anything at all. This is called tolerance; it is natural and not considered part of the addiction process.
Similarly, some people have pain that isn’t managed properly. According to the American Society for Pain Management Nursing, these patients can be considered “pseudo-addicts.” They may demand high amounts of pain medication, and they may seem angry and unreasonable as a result. But, again, these patients are not considered addicts, as these behaviors tend to disappear when they’re given the proper amount of pain control.
Addicts, by contrast, are driven and compelled to use medications. They may use the medications even though they:
- Have no pain or very low pain
- Know the use of the medications is impairing other areas of their lives
- Should stop using the medications in this way
- Are using the drugs to get high, instead of using them to control pain
Addiction is a disease of compulsion. These people have underlying neurological changes that render it physically impossible for them to stop using the medications, even though they might want to do so.
Treating pain properly means addressing where patients fall in this continuum and then adjusting the medications provided, and when they are provided, to meet the needs of these individual people. Pain management isn’t a one-size-fits-all affair. The methods must be adjusted for the specific requirements of the patients.
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Helping Pseudo-Addicts With Pain
In the Primary Care Companion to the Journal of Clinical Psychiatry, authors outline a case of a patient with pseudo-addiction. The man was a recovering alcoholic who endured a low-back injury. He requested increasingly higher doses of pain medications, but his doctor feared addiction issues and didn’t provide the medications. As a result, the man lapsed back into addiction to alcohol. This is a tragic consequence of under-treating pain in people recovering from addiction. The man and his doctor wanted to avoid a relapse, but in so doing, they forced the man into a relapse. His pain didn’t abate, and he did what he could to deal with the issue alone.
In order to avoid problems like this, pseudo-addicts need open and clear discussions with their doctors about their pain levels. Frequent visits to the doctor, where the patient can clearly demonstrate pain and low function, can help the two sides build a team approach and work together to help resolve the issue. In addition, pseudo-addicts must do their part to be honest about their pain, and stay on the lookout for signs of compulsive use and true addiction. If the pain is gone but the person still wants to take more drugs, there may be an addiction forming.
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Accounting for Tolerance
This same article in the Primary Care Companion to the Journal of Clinical Psychiatry points out that people who have a history of drug abuse often have developed a tolerance to pain medications. Low doses of pain medications may have no effect whatsoever, as the person is accustomed to simply taking doses like this for recreational purposes. As a result, these patients may need higher doses of medications at the outset, just to deal with pain.
Another approach outlined by the World Health Organization might also be helpful. Here, the medications are provided in a stair-step approach, and painkilling narcotics are not the first medications given. Instead, at the onset of pain, the patient is given a medication such as aspirin or acetaminophen. If this doesn’t work, a mild opioid is added to the mix, such as hydrocodone. If that still doesn’t control pain, a stronger opioid is used, such as morphine. These medications are given at specific times, instead of on an as-needed basis, so the addict doesn’t need to deal with hills and valleys of pain control.
Some tolerant patients may benefit from this approach, as they’re getting many different types of medication on a regular basis. They aren’t just given a medication that might not help them, and they have the ability to ask for and receive higher levels of drugs if they need them.
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Addiction and Pain Control
People in recovery from addiction, including people who are using methadone or buprenorphine to control addiction cravings, still need access to pain control. This can be a bit of a delicate dance. The stair-step approach described above might be helpful for these patients, as they receive control for their pain from a variety of sources, but these patients might also need to take the stairs back down when their pain is controlled. In other words, these patients might be given access to medications to control pain, but when the primary problem has been resolved, they work with their doctors to taper away from the use of the drugs.
There are some addicted patients in recovery who simply do not want to take any narcotic substances, no matter the reason. It’s a personal decision, and the patient certainly has the right to make that choice. For these patients, alternative medicine may provide relief. Participating in meditation, yoga, acupuncture or massage may alleviate pain without the use of drugs, and it may allow the addict to feel healthier and in control of the addiction even during a medical crisis. The American Pain Foundation reports that these methods can be helpful for some patients, but patients should be sure to work closely with their doctors during this process. These tips may help:
- Tell the doctor about all herbal remedies and vitamins taken.
- Ask the doctor to outline the risks and benefits of the alternative medicine therapy chosen.
- Ask if the method under consideration will interfere with other medications or treatments the doctor is providing.
- Be clear about pain levels, and speak up if the pain is not abating.
The Role of Rehabilitation
Addiction is a chronic condition that can flare up and die back down. People in pain who also have an addiction issue may have an outbreak of the addiction after using pain control. It’s a fact of life, and it’s not considered a moral failing or weakness. It’s just part of having a chronic condition that must be maintained on a regular basis. For this reason, some people choose to enter a touch-up rehabilitation program after they take pain medications for a period of time. They may meet with counselors to discuss the experience and strengthen their resolve to stop using medications. Or, they may enter formal detoxification programs and start the whole process once more, from the beginning, to remove the drugs from their systems and learn new skills to prevent another issue from occurring. Many addiction programs provide this form of long-term care to help addicts who need support in a crisis. For some, this is just the end of the pain control process.
Fears of relapse, detoxification and rehabilitation shouldn’t keep people from getting the pain control they need, however. Pain is real, and it’s debilitating enough that it can lead to an addiction if left untreated. The key is to be aware, alert and open to help from doctors. Please call us at Michael’s House to find out more.
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