Chronic Pain And Addiction

How Chronic Pain Can Lead To Addiction

Chronic pain is persistent pain lasting 12 weeks or more, often occurring after an injury or procedure. Studies show that 1 in 5 Americans suffer from chronic pain, and half of people with a substance use disorder experience chronic pain, illustrating a strong relationship between the two.

Chronic pain not only causes physical discomfort but also significantly impacts many aspects of a person’s life, including their ability to work, maintain relationships, and manage their household. This can result in emotional distress, loneliness, and depression. It can also lead to decreased mobility, changes in appetite, stress sensitivity, and mood swings.

People with chronic pain often find relief through substances like prescription opioids, alcohol, marijuana, and other drugs to help control their pain without the intention of becoming addicted.

In medical settings, prescription opioids are the mainstay treatment for chronic pain, despite evidence that opioid management for chronic pain is not always an effective treatment approach.

Below are a few theories of how chronic pain leads to addiction:

Self-medication for both physical pain and emotional pain: The misuse or abuse of illicit drugs or prescription opioid medications to control untreated pain or emotional stress caused by untreated chronic pain is considered self-medication. This can mean:

• Taking a higher dose than prescribed
• Taking a medication more frequently than prescribed
• Taking someone else’s prescription
• Purchasing illicit medication to treat uncontrolled pain

People with chronic pain may also self-medicate their emotional stress, depression, and loneliness caused by chronic pain.

Stress-induced hyperalgesia: Chronic pain is tightly linked to chronic stress, which can lead to “wear and tear” on the body. Over time, this can cause hyperalgesia (increased sensitivity to pain), worsening their already present chronic pain.

Opioid-induced hyperalgesia: Opioids have been shown to induce hyperalgesia, worsening both acute and chronic pain. This can lead to the need for more opioids to treat the pain, creating a vicious, uncontrolled cycle.

Central sensitization: Central sensitization is a phenomenon that causes abnormal pain processing in the brain and spinal cord. In those with this condition, their spinal cords continue to send pain signals to the brain, while the brain struggles to turn off these signals, leading to a greater pain response. People with central sensitization are more likely to report pain as a major cause of their opioid addiction. They are also less likely to seek treatment for their opioid addiction out of fear that their pain will cause them to relapse.

Common Causes Of Chronic Pain

Chronic pain can occur anywhere in the body and can be caused by many different factors, such as:

• Injuries, such as trauma (accidents and surgeries), soft tissue damage (sprains and strains), and broken bones.
• Infections, like Lyme disease
• Medical conditions associated with chronic pain, including arthritis, fibromyalgia, and endometriosis, neuropathic disorders such as diabetic neuropathy, and autoimmune disorders such as multiple sclerosis.
• Lifestyle factors, like poor posture, overuse injuries, and obesity.

Chronic pain can also be caused by a combination of factors. An injury from a strain can result in inflammation, which can cause nerve damage and result in chronic pain.

Chronic pain in one part of the body may cause discomfort in other areas. For example, someone with post-traumatic pain (pain resulting from a car accident, surgical procedure, or other physical trauma to the body) may also experience:

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What’s The Link Between Chronic Pain And Opioid Abuse?

There are many different treatment modalities for chronic pain, ranging from NSAIDS, physical therapy, steroids, antidepressants, and antiepileptic drugs such as gabapentin, to prescription pain medications, such as opioids.

Although opioids may be able to reduce pain, they also elicit feelings of euphoria, which is one of the main culprits for opioid misuse.

Opioids bind to the mu opioid receptors in the brain, which work to do the following processes:

• Block pain signals to the body and result in reduced pain
• Release dopamine, which creates feelings of pleasure, euphoria, and reinforcement
• Depresses the central nervous system functions, causing slowed breathing and sedation

Prescription opioids can be an important medication for certain types of chronic pain and do have their place in the treatment of chronic pain, such as cancer-related pain. Still, they are often overprescribed by medical professionals and misused by patients. They carry considerable risks such as overdose and opioid addiction.

Over 100 million people in the United States have chronic pain, and more than 20 million experience severe, debilitating chronic pain. Unfortunately, due to many factors within the healthcare system, many of these people with chronic pain are left untreated. These people who are untreated may turn to illicit medications such as heroin to treat their pain.

The opioid epidemic is deeply rooted in the overprescribing of opioids to treat patients who have chronic pain. Although opioid prescribing has decreased since the 2016 CDC Opioid Prescribing Guideline recommendations went into effect, prescription opioids are still the most commonly misused prescription drug in the United States.

How Does Opioid Use For Chronic Pain Develop Into Addiction?

When repeated doses of opioids are used, the brain adapts to the drug’s presence, and continuous exposure to opioids will result in tolerance.

When a patient builds a tolerance to opioids, their current dosage no longer treats their pain because their brain and body have adapted to the opioids. This means that they need more of the medication to maintain the desired effect, in this case, pain relief.

Prescribing physicians may or may not fulfill this need by prescribing higher doses of opioids, but when the physician has reached the therapeutic and legal limit for what they can prescribe, patients transition from prescription medications to illegal street drugs.

Another common scenario for opioid abuse in the presence of chronic pain is the craving for euphoria from prescription opioids. Because opioids are known to release dopamine, resulting in euphoria, patients may crave these pleasurable psychological feelings and may continue to misuse opioids to chase this high.

A patient who is struggling with chronic pain may also be struggling with stress, loneliness, and depression, as chronic pain can take an emotional and psychological toll on the body and can drive someone to misuse opioids as a way to numb their emotional pain.

Regardless of why people are taking opioids, over time, they can develop tolerance and dependence on opioids.

Opioid Dependency Vs. Addiction

Opioid dependency occurs when the body feels that it needs the opioid to function normally. This is because the brain and body have become rewired in the presence of opioids and have become “dependent” on them to carry out basic functions.

When someone tries to cut back or stop taking opioids, they will experience withdrawal effects. Although opioid withdrawal effects are not life-threatening, they can be incredibly uncomfortable and even painful. This is a common reason why people continue to use opioids.

Opioid addiction encompasses cravings and urges to use opioids despite the harmful consequences they cause in multiple aspects of a person’s daily life. Whereas dependence refers to the biological changes opioids have on the body, addiction is a psychological, all-encompassing disorder that affects every aspect of a person’s life. Someone can be dependent on opioids but not have an addiction.

How Can We Reduce The Risk Of Addiction In Chronic Pain Patients?

Reducing the risk of opioid addiction in chronic pain patients starts with educating the general public and medical professionals on the harmful effects of opioids and the mainstay ways to treat chronic pain that do not involve opioid medications. Depending on the type and cause of chronic pain, many evidence-based (non-opioid) medications can be used as first-line treatment for chronic pain.

Non opioid medications that are commonly associated with chronic pain relief include:

• Anti-inflammatory medications
• Steroids (Prednisone)
• Muscle relaxers
• Antidepressants
• Anticonvulsant and anti-seizure medications

If over-the-counter medications are not strong enough to manage chronic pain, a doctor may prescribe anti-inflammatories or muscle relaxants. However, muscle relaxants have the potential to be addictive. Antidepressants may also be effective in treating symptoms of depression that often accompany chronic pain. In addition to medications, non-drug treatments that focus on lifestyle modifications, mobility, posture, and strength training play an important role in managing chronic pain.

What Are Non-Medication Options For Chronic Pain?

Treating chronic pain can also involve non-medication treatments. The following are non-medication options that can be used to help alleviate chronic pain:

• Massage therapy
• Botox
• Cupping
• Acupuncture
• Electrical stimulation, such as transcutaneous electrical stimulation
• Meditation
• Yoga
• Physical therapy

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How To Stop Taking Pain Medications

Stopping pain medications is a process that should be guided by a medical professional, as stopping opioids cold turkey is not recommended due to the high potential for relapse.

Opioid withdrawal side effects may occur if someone who is dependent on opioids stops taking pain medications. Depending on the severity of the pain medication abuse or addiction, detoxification may be the first step in stopping pain medications.

Detoxification involves providing both prescription and over-the-counter medications to ease withdrawal side effects and monitoring the patient in a calm and controlled environment. Once detox is completed, the patient can be assessed to see if they need addiction treatment. If formal addiction treatment is needed, a care team will determine if inpatient or outpatient care is needed. During addiction treatment, psychotherapies and medications are administered to build healthy coping skills for everyday life.

Find Support Today

Long-term use of opioids may worsen pain as time progresses. Being proactive about an opioid use disorder can reduce complications in the future. If you or your loved one is experiencing challenges with chronic pain and has become physically dependent on opioids, don’t hesitate to seek help. Contact a treatment provider or visit our rehab directory to explore your treatment options today.