how to manage pain in addicted patientsBy Elizabeth Ossip, LCSW, CAP, ICADC

For people in recovery from addiction and alcoholism pain management can be complicated and challenging. The introduction of opioid pain medications can trigger a relapse or develop into an addiction to yet another substance. For those with a history of opiate addiction it is, of course, a primary concern, but for alcoholics and people addicted to other substances, it can also be a problem. The road to relapse is a slippery slope and without careful guidance from a knowledgeable pain management addiction specialist who is familiar with addictions and complete transparency by the patient, the prescribing of narcotic pain medication can be hazardous.

Addiction is a subtle and patient foe. Years into recovery, many sober alcoholics have relapsed or developed secondary addictions after taking prescribed pain medication. The medication triggers dormant brain responses and begins the cycle of addiction all over again. The addictive behavior may not appear immediately. The person may begin by taking the medication longer than necessary or take their dose sooner than indicated, eventually “doubling up” and exceeding the prescribed dose. Or, they may revert back to their original substance of choice or another substance. Any person with an “addictive personality” needs to use caution when dealing with pain. After all, addiction is often brought on by a need to numb feelings, as a maladaptive coping mechanism to manage emotional and or physical discomfort.

According to the NIH, “Chronic pain affects an estimated 100 million Americans, or one-third of the U.S. population” [NIDA. (2017, May 12). Statistics also show that over 2 million people in the U.S. have a substance use disorder. Many more may be unreported or may be in longterm recovery. The problem of treating those with co-occurring pain and addiction becomes clear when realizing these numbers. Many addicts and alcoholics may be fearful of treating their chronic pain, due to the risk of relapse. Ironically, the stress caused by lack of treatment for pain may also be a driving force in the relapse of addiction. This creates an obvious dilemma.

Fortunately, pain management for recovering addicts is possible. First, medical care from a physician that is knowledgeable about both addiction and pain management is essential. Complete honesty and openness by the patient is also crucial. If you have a history of addiction or alcoholism, or if there is a family history, it is imperative to share this with your doctor. Question all prescriptions for pain medication and educate yourself on what is potentially addictive or triggering. Have a frank discussion with your doctor and if they don’t seem knowledgable or seem to minimize the risk, get a second opinion.

There are many alternative treatments for pain that can be very effective, such as acupuncture, chiropractic, massage therapy, meditation and many other non-drug options. A thorough exploration of these many techniques may bear fruitful results.

Seeking support from a therapist or counselor may also be advisable. Having chronic pain can lead to depression and can increase anxiety. Getting mental health assistance can help with these issues and be a source of advocacy and understanding. Having family members as part of your care team can also be very important.

Getting education and information for the family is the first step and again, honesty and openness is important to establish trust and understanding. Including them in the care planning process may help to alleviate their fears. A trusted family member may be one of the best allies in guarding against a problem.

If an addiction does develop due to pain management medication it is of the utmost importance to seek treatment immediately. The longer you wait, the more difficult it will be. Once you think you may have a problem, you do. Delaying treatment will only make the problem worse and the pain will likely get worse too. There is some evidence that addiction to pain medication actually seems to to increase or exacerbate the pain. The brain signals the body to get more of the drug by highlighting the pain. Once addiction treatment begins and the acute withdrawal phase is passed, the pain actually often decreases. Talk to your doctor and seek help. There are solutions and no one needs to suffer with pain or addiction.