Chronic Pain Management with Opioid Therapy
While the majority of chronic pain sufferers need only concern themselves with pain management, a small segment could face a double whammy in the form of opioid addiction.
A recent study conducted by Geisinger Health System and New York University researchers found that 35% of patients with chronic pain who were being treated with opioid therapy met the American Psychiatric Association’s definition of an addict. The study worked from a random sampling of electronic health records for outpatients receiving extended opioid treatment for non-cancer pain.
Patients with long-term pain are most often prescribed drugs like Vicodin, Hydrocodone, OxyContin, or Percocet, all of which are opiate-based and can be highly addictive. A 2006 study reported that 90% of patients treated for chronic pain are prescribed opioids.
It is important to note that not all, not even a majority of patients receiving such medications for their pain, will become addicted to them. The American Pain Society says less than 3 percent of patients being treated for long-term pain will become addicted as long as there is no history of drug abuse. Similarly, the National Institute on Drug Abuse reports that 7 percent of chronic pain patients taking opioids will develop a dependency.
Risk Factors for Opiate Addiction
There are risk factors that can help predict which patients with chronic pain are most susceptible to forming an addiction to prescription painkillers. While it is usually not known if patients are genetically predisposed for addiction, there are other more discernible risk factors. Patients under the age of 65 with a history of substance abuse or withdrawal symptoms are in the risk category. Patients with a history of anti-social personality disorder are also at risk.
For those who form an addiction to opioids for pain management, there is a cycle or spiral which commonly manifests. With time and increased use, the drugs seem not to deliver the same level of pain relief. Use increases and relief decreases which is referred to as tolerance. At this point, the patient takes greater dosages in order to find relief. This ascending spiral is what creates physical dependence.
Soon the patient’s body is so accustomed to the presence of the drug that he/she senses a need for the drug just to feel normal. The drug is not delivering pain relief; in fact, it could be making the pain worse. As the body’s tolerance for the drug increases, the pain threshold decreases meaning that the patient actually feels more pain even though they are taking higher doses or more frequent doses of the prescription medication. This phenomenon is referred to as opioid-induced hyperalgesia.
Overcoming Opiate Addiction
Fortunately there is a way to escape the spiral. To begin with, it is the hope of the researchers involved in this study that new classes of medications will be developed that do not affect the brain in ways that can lead to addiction. Until those new drugs are available there are other options.
For the patient already addicted to painkillers, weaning off the medications should take place under a doctor’s care. Patients who suddenly stop taking opioids can expect to experience withdrawal symptoms ranging from muscle aches, insomnia, agitation, and vomiting to bone pain and strong drug cravings. With a doctor’s care it is possible to see the cessation of withdrawal symptoms in two to three weeks.
Once the patient is drug free, pain can be managed with other, non-opioid medications. In fact, most types of long-term pain respond favorably to pain relievers and anti-inflammatory drugs such as aspirin, ibuprofen, and acetaminophen. Physical therapy sessions can help to reduce pain and cognitive behavior therapy can help patients to manage pain in other ways. There is a way out for those addicted to prescription pain medication.
