The Slippery Slope of Pain Management: The Guide to Preventing Addiction for People with Chronic Pain

America is facing a serious addiction problem: according to the Centers for Disease Control (CDC), about 40 Americans die every day from overdosing on prescription painkillers. In 2013 alone, an estimated 1.9 million people abused or were dependent on prescription opiates.

Although it’s clear that chronic pain patients face a risk of dependency by the mere introduction of highly-addictive opioids into their system, there is no clear statistic to indicate an overall addiction rate. Estimates range anywhere from 3 percent to 40 percent, but the numbers vary due to differences in treatment duration, a lack of research on long-term outcomes, and the disparate study populations and measures used in assessments. So how do you know if you’re really in danger?

This guide will help give you a better understanding of the dangers and realities of treating your chronic pain with opioids. It will discuss how and why opioids are such an addiction risk, how to prevent becoming dependent on your medication, alternative therapies, and what to do if you think you have a problem. While this guide is meant to help you understand what treatment options may be available to you, always consult your doctor before making any changes to your pain management routine.

Why Do We Get Addicted?

One of the biggest problems with prescribed opiate use is that many people become “tolerant” — over time, small doses must be increased in order to create the same effect. Our bodies not only require more, they demand it with intense cravings and withdrawal symptoms. This is especially risky with chronic pain patients because it can be difficult to gauge whether your condition is truly worsening or you’re simply becoming resistant to your medication.

What’s truly alarming is that even those who aren’t abusing their opioid prescription can become dependent and go through withdrawal. When the dosage is stopped or even just reduced, patients may experience sweating, chills, nausea, vomiting, diarrhea, muscle and joint pain, restlessness, and insomnia. Just the fear of these kinds of effects can make it difficult to stop taking the drugs, especially if there are other pre-existing, chronic pain conditions — like the one being treated by the medication — that worsen in addition to withdrawal symptoms.

How to Reduce Your Risk

The first step in reducing your risk for addiction is to be honest and open with your doctor. When initially coming up with a pain management routine, your doctor should first screen you for potential addiction risk factors like personal or family history of drug abuse and history of mental illness. Don’t be afraid to be honest about any past battles with addiction — even if it was with alcohol or another substance — and do as much research as you can to get information on your family’s history. It’s important to be as informed as possible because addiction is due 50 percent to genetic predisposition. Remember, your doctor’s intention isn’t to be nosy or pass judgment; he needs all the facts to give you proper treatment without creating additional issues. Failing to give him all the information could put your health at serious risk and prevent him from being able to set you up for success.

If your doctor decides that a prescription opiate is the right treatment option for you, get as much information as possible about the medication and treatment plan. Consider the following questions:

  • Is the opiate absolutely necessary to your pain management and everyday function?
  • What are the risks and side effects?
  • What are the benefits to the treatment of your condition?
  • How long will you be taking the opiate?
  • What is the end goal, and how will you both know when it’s been reached?

When beginning an opiate prescription regimen, talk to your doctor about starting with a low dosage taken at a slow pace. Ideally he will set up a regular routine to check in with you to ensure that your medication is working as it should, you aren’t becoming dependent, and that the benefits of the medication outweigh the risks. There should be a clear end point on the horizon — you should know exactly when your doctor aims to start weaning you off the opiate, or if he doesn’t, how the dosage may change over time.

Read the label on your prescription and any other literature your physician or pharmacist may provide. Take it exactly as directed and never combine it with alcohol. Don’t begin taking any other new medications without consulting with your doctor, especially anti-anxiety medications (like Xanax and Valium). If you develop a cold, bronchitis, asthma flare-up, or any other kinds of respiratory problems that make it difficult to breathe, let your doctor know immediately as you may need to lower your dosage until you recover.

Don’t drive or do anything that requires you to be fully alert until you know exactly how the medication affects you. This is especially important when you first begin taking the drug or if you change your dosage. If you think it may affect your work, talk to your boss — you don’t have to provide the details, but you should let her know you’re starting a new medication and go over a few of the potential side effects. You can even ask your doctor to provide written documentation if you’re uncomfortable having a conversation about it. Don’t let the fear of judgment put your career or life at risk.

As your physician does his regular check-ins, it’s important to be honest about your condition and experience with the opiate. If you feel that the medication is working but negative side effects are outweighing the benefits, discuss making a change. Consider not only how the drug makes you physically feel, but where you stand with it from a mental standpoint. Do you find yourself thinking about and anxiously anticipating your next dose? Do you ever become fixated on the idea to the point it distracts you from everyday tasks? It’s a fine line between anticipating feeling better and wanting a “fix,” so give your doctor a call the moment that your thoughts begin to show signs of dependency. Keep in mind he may issue urine tests and other measures to verify that you’re taking the drug as prescribed — safety measures meant to keep you on track and at reduced risk of becoming addicted.

As a general rule, if your pain or daily function do not improve by at least 30 percent after starting your regimen, the opiate likely isn’t working well enough to justify the risks. You should only increase your intake at the direction of your doctor, and only when absolutely necessary. If you notice your symptoms starting to worsen, keep a written record of exactly what you’re feeling, when it tends to happen, and with what frequency. Try to compare your current symptoms to how you felt before taking the opiate — it may be helpful in distinguishing between dependency and drug tolerance.

Alternative Therapies

Opioids work well to alleviate two main kinds of pain: short-term pain (like that associated with injury and post-operative treatment) and pain associated with terminal or very serious illnesses (like cancer). The problem with using opioids to treat chronic pain is that there is little evidence to suggest that long-term use helps people do more or get around more easily. In fact, a 2010 study of more than 1,000 chronic pain sufferers showed that most patients taking opioids reported still suffering moderate to severe pain that interfered with everyday activities. There also hasn’t been much research on how safe it is to use opioids for long periods of time; most studies involved lower-risk patients using drugs for only a few weeks, and few have compared opioid use to safer options like over-the-counter medication or non-drug treatments. For chronic conditions, research suggests that other medications and non-drug options often provide relief with significantly less risk.

What is known, however, is that the higher the dose of an opioid and the longer you take it, the greater your risk for dependency or addiction. They can also come with their own side effects: nausea, vomiting, and constipation, as well as a “fuzzy-headedness” feeling that can make it difficult for people to focus. Long-term use has a special set of risks: it can affect sex hormones (lower sex drive, disruption of menstrual cycles in women), weaken your immune system, and even make people more sensitive to physical pain.

Talk to your doctor about your options for pain management. Some kinds of pain (nerve pain, migraines, fibromyalgia) often respond better to prescription medications other than opioids, including acetaminophen, ibuprofen, or naproxen. There are also non-drug treatments like physical therapy, massage, biofeedback, acupuncture, and hypnosis.

How to Recognize if You Have a Problem and What to Do Next

It’s important to recognize the warning signs of opioid addiction before it gets out of control:

  • Drowsiness
  • Change in sleep habits
  • Decreased libido
  • Weight loss
  • Changes in exercise habits and/or energy level
  • Loss of relationships and social connections
  • Changes in work or school habits (excessive tardiness or absence, missing deadlines, forgetting to complete homework assignments)

One of the most telling signs of a problem is lying to your doctor, your loved ones, or yourself about your habits. If you start to think you have a problem but aren’t comfortable talking to your doctor, confide in a trusted friend or family member. Sometimes it’s easier to admit you have a problem if you have someone with you who loves and supports you. You can even ask your loved one to come with you to speak with your doctor and get you on the road to recovery.

There are many ways to treat your chronic pain, so explore all your options before committing to treatment with an opioid. Whether or not you’ve ever had a problem with any kind of addiction, substances this powerful can leave anyone vulnerable. Work with your doctor to find a regimen that works for you, and don’t be afraid to ask questions along the way.