Chronic Pain and Opiate Abuse

Chronic pain and opiate abuse are co-occurring disorders that are difficult to treat. Chronic pain is a serious health condition. This condition often leads to complications such as depression, anxiety and difficulty sleeping. It becomes more difficult to keep up at work, manage tasks at home and attend social gatherings. This may lead to relationship problems and even  financial instability. Some research even suggests that the more severe the pain, the more serious these problems.

Many people turn to prescription drugs to relieve their pain. Medicating the pain then becomes a way of life. This makes the problem of co occurring disorders — chronic pain and opiate abuse — hard to treat.

The Center for Disease Control and Prevention describes abuse of prescription drugs in the U.S. as a growing and deadly epidemic.

In the United States, 50 million people  have some form of acute or chronic pain. The numbers are even higher among older adults. In 2014, retail pharmacies dispensed 245 million prescriptions for opioid pain relievers. In 2015, 27 million Americans 12 or older had a substance use disorder. 591,000 had a substance abuse disorder involving heroin. Of these, about 23% who used heroin develop opioid addiction.

CHRONIC PAIN VS. ACUTE PAIN

What is the difference between chronic pain and acute pain?

Acute pain can come on suddenly caused by something specific. It can be mild pain, lasting for just a moment. It could also be severe pain, lasting for weeks or months.

Usually, acute pain goes away when the cause of the pain heals or goes away. Life, then, goes back to normal.

Prescription opioids are prescribed for acute pain as a result of traumatic injury, such as surgery or a broken bone. Examples of acute pain includes surgery, broken bones, dental work, burns or cuts and labor during childbirth.

Chronic pain is ongoing pain that is long term (more than six months). Even after the injury or illness heals, this type of pain can continue. Pain signals can remain active in the nervous system for years. Sometimes, people suffer from chronic pain even when there is no apparent injury. Such conditions include headache, back pain, Arthritis, Cancer, and Fibromyalgia.

With chronic pain, the physical effects include tense muscles, lack of energy, appetite changes and limited mobility. Emotional effects include depression, anger, anxiety, and fear of re-injury. This fear may be debilitating as it may limit an individual’s ability to return to work or leisure activities.

OPIATE PRESCRIPTION FOR CHRONIC PAIN

In recent years, the number of prescriptions for opioid pain relievers has increased dramatically. At the same time, there has been an increase in treatment admissions for prescription opioid addiction and accidental overdoses.

Deaths in the U.S. from prescription opioid overdose have grown sharply from approximately 4,000 in 1999 to 64,000 in 2016.

In 2016, the leading cause of accidental death in the US is a lethal drug overdose. Opiate addiction is driving this epidemic, with two-thirds of these deaths related to prescription pain relievers. Fentanyl showed the sharpest increase with over 20,000 overdose deaths.

According to the National Institute on Drug Abuse (NIDA), Fentanyl is similar to morphine but is 50 to 100 times more powerful. It is used to treat patients with severe pain or to manage pain after surgery. Some doctors prescribe fentanyl for patients who have developed a tolerance to other opioids. 

Opioids copy the natural pain-relieving chemicals called endorphins produced by the brain. Such prescription drugs reduce the pain temporarily. They also tend to interfere with other nerve cell functions, such as breathing, heart rate and level of alertness.

Currently, the rate of opioids deaths is still rising. Because the risks are so great, physicians prescribe opioids at low doses and usually for just a few days.

Over time, your body adjusts to these medications. This means you will need to take stronger doses to feel the same pain relief (tolerance). Long-term use of opioids may lead to dependence on these medications and, eventually, addiction.

Doctors concerned about prescription abuse may undertreat pain.  When the drugs that individuals are taking are no longer as effective, long term users of opiates or opioids may turn to drinking or get high as a temporary fix to relieve the pain.

CO-OCCURRING DISORDERS  

Co-occurring disorders can be sometimes be difficult to diagnose because of the complexity of symptoms and each may vary in severity.

According to Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2014 National Survey on Drug Use and Health, about 7.9 million adults had co-occurring disorders.

People suffering from chronic pain may use alcohol, tobacco, and opiates to temporarily ease their pain. In some cases, people can receive treatment for one disorder while the other disorder remains untreated. This sometimes occurs because chronic pain and opioid addiction can have psychological, social and biological components.  Insufficient or poor provider training and screening lead to misdiagnosis or bad treatment.  Overlapping symptoms, and other health issues, should be addressed at the same time.

Co-Occurring Disorder Challenges

If the individual with co-occurring disorders is left to carry on ‘business as usual’, after some time, he may care about very little else other than getting his hands on opioids to relieve pain.

According to the National Institute of Health, between 3% to 5% of people receiving medication to manage chronic pain will, eventually, become dependent on it. If a patient is already taking medication such as Oxycontin or Percocet and believe they might be addicted, then seek professional help.

With chronic pain and opiate abuse, an overdose is potentially fatal and can also cause severe liver damage.

In 2011, the Center for Disease Control and Prevention released findings that stated that, more people died due to overdosing on legal pain medications than on illegal drugs.

Finding an effective treatment is a critical goal. Unfortunately, this process is complex and uniquely personal. What works for one person’s chronic low back pain may not offer any relief for osteoarthritis, for a number of reasons. Personal history, biology and diagnosis all play a role. Therefore, finding pain management treatment that address co occurring disorders such as chronic pain and opioid addiction can be a lengthy effort.

TREATMENT FOR CO-OCCURRING DISORDERS   

People with co-occurring disorders are best served through integrated treatment. According to SAMHSA, integrated treatment for co-occurring disorders differs from traditional approaches in several ways:

• Services are first organized in an integrated fashion. For example, integrated treatment specialists or practitioners conduct assessment screens for co occurring disorders. These practitioners develop plans that treat both chronic pain and opiate abuse. This helps the patient stay on track and focussed on recovery for co occurring disorders. Patients receive one consistent, integrated message about chronic pain and opiate abuse. In this way, they do not get confused or feel excluded because they are going back and forth between different doctor appointments.
• Treatment specialists are then able to integrate clinical treatment as they have knowledge of both chronic pain and opiate abuse disorders. They have a deep understanding of the complexity of interactions between co-occurring disorders.
• With an integrated treatment program, practitioners can address chronic pain and opioid addiction at the same time. This often lowers costs and creates better outcomes.

With co-occurring disorders such as chronic pain and opiate abuse, early detection and treatment can improve treatment outcomes and quality of life.

NON-NARCOTIC CHRONIC PAIN TREATMENT

According to the American Society of Anesthesiologists (ASAHQ), there are alternatives to help manage chronic pain and opiate abuse. These include:

• Physical therapy – A trained physical therapist specializing in physical medicine can customize an exercise program that helps to improve the patient’s ability to function and decreases his/her pain. Such programs include ultrasound, deep-muscle massages and whirlpools.
• Acupuncture – Alternative therapy where very thin needles are inserted into targeted areas of the body to interrupt pain signals.  
• Surgery – Surgery can be performed to correct abnormalities in the body responsible for pain.
• Injections or nerve blocks – For those experiencing muscle spasms or nerve pain, injections with local anesthetics or other medications can help alleviate pain.
• Holistic therapies — This includes massages and other relaxation techniques. There is also the option of biofeedback, where one controls involuntary functions such as the heart rate.

New Techniques

ASAHQ outlines a few of the new techniques that are being developed that may help to relieve chronic pain. In some cases, these may even keep it from coming back.

These include:

• Radiofrequency ablation – This method uses radio waves and involves inserting a needle next to the nerve responsible for the pain.  An electric current created by radio waves burns the needle.  This short circuits the pain signal.  In this case, pain relief can last for up to 12 months.
• X-ray imaging and nerve blocks. Physicians can inject medication that numbs and blocks or dampens pain. It may even stop chronic pain from developing. The source and type of pain determine the medication injection’s location.  For example, blocking nerves in the neck relieves face and arm pain.  However, the patient may require more than one injection and repeated treatment.
• Transcutaneous electrical nerve stimulation provides short-term pain relief. Low-voltage electrical signals run from a small device directly to the pain.  The signals run through pads attached to the skin.  This is a viable option especially for various types of muscle pain. This stimulation interrupts the nerve signals to the brain or stimulates the production of “feel good” endorphins, the body’s natural painkillers.
• Spinal cord stimulation (SCS) is used as a last resort when other techniques fail. SCS uses a pacemaker-like device that takes away the pain and replaces it with a more tolerable sensation, typically a tingling or massage-like feeling.  Professionals implant the device into the lower back.  The device attaches to tiny wires located in the spinal canal.   Patients can use a remote control to send signals to the pain area whenever they feel pain. People with chronic back pain should consider this as a non narcotic treatment option. This includes people who are diabetic and who sometimes suffer from neuropathy (nerve damage in the legs that causes numbness and pain).
• Special pumps are implanted in the spinal cord to deliver pain medication to a patient’s spinal cord. This technique provides a huge psychological boost as the patient feels that he has direct control over his pain. Patients suffering from cancer pain and people who experience side effects when taking oral medication can consider this treatment.

Sometimes, extended-release pills, which contain relatively large doses of the extra drug are abused. Although the drug is intended to be released over a prolonged period, abusers frequently destroy the time-release mechanism by chewing, crushing or dissolving the pills in household beverages or solvents.

Neuropathic pain is a particularly elusive type of chronic pain.  It is often treated with opiate painkillers, but that’s not the right approach.  Scrambler Therapy is a useful non-narcotic approach to treating chronic neuropathic pain.  Learn more.

In response to widespread prescription opioid abuse, the U.S. government and a few state legislatures have introduced, and even enacted, legislation and regulations intended to encourage the development of abuse-deterrent forms of pain medications. The Food and Drug Administration (FDA) has stated that addressing prescription drug abuse is a priority, and the development of abuse-deterrent opioids is a key part of that strategy.

CHRONIC PAIN AND OPIATE ABUSE

Chronic pain and opiate abuse are co occurring disorders that require specialized professional treatment. Individuals struggling with chronic pain and opioid abuse should look for a specialized treatment facility. It is crucial that the facility offers an integrated program that helps patients manage chronic pain and opiate abuse. Counseling is often a major component of treatment.

It is important to know what the options are in order to help them come off opiates for good. The transition period is understandably the most traumatic. An inpatient facility that includes an integrated detox and rehabilitation center is the best case scenario for most patients.  Checking into a facility is very beneficial because it will remove environmental stresses that might motivate the patient to seek out illegal supplies of the drug and relapse or form other addictions as a substitute.

After detox, begin an outpatient or residential treatment plan tailored to address your specific needs. With the help of professionals you will learn to develop the skills needed to cope with negative emotions, like anger or loneliness, without relying on a substance.

The rehab staff will help you build the coping skills needed to avoid opiate abuse and relapse. Alternative therapies, such as meditation, acupuncture and massage therapy, reduce discomfort as well.

Every addict has his/her own journey to recovery. Each journey includes unique challenges, obstacles and risks. The best thing to do is to stay determined throughout the process, face the fact that the recovery process will be difficult but maintain a dogged perseverance to overcome chronic pain and opiate abuse and to maintain a life of sobriety.

Recovering Champions on Cape Cod specializes in the treatment of co-occurring disorders.  Take your first step to long-term recovery by contacting our staff right now!