What is Chronic Pain?
Chronic pain is a grave issue for both health care practitioners and patients. It can be defined as any pain that persists for more than 3 months, no longer has physiological usefulness, or is part of a severe and incurable disease or illness. In some cases, the cause of the pain may be completely unknown. Whatever the case may be, chronic pain often makes it difficult for individuals to function normally and is likely to affect
- Sleeping patterns
- Emotional and mental states
- Activity and production levels
- General physical health and well-being.
Chronic pain can have many causes, such as serious injuries, arthritis, back or neck pain, musculoskeletal problems, severe migraines, and incurable or unmanageable diseases and conditions. When problems like these arise and cause unmanageability in the lives of the sufferer, opiate-based painkillers are the preferred source of relief for medical practitioners. Although most new cases of chronic pain are not initially treated with the most powerful of opiates available, unless or until the pain problem is resolved, tolerance to the drugs will grow over time and eventually higher doses or more powerful opiates will become necessary to manage the same degree of pain.
Therein lies the quagmire with chronic pain management and opiates.
Opiates and how they Work
Some of the most powerful pain medications on the market today are opiates and opioids. Drugs in the opiate family are manufactured directly from the dried sap of immature poppy plant seeds. The sap can be utilized to make a wide array of potent drugs such as morphine, heroin, and codeine. Opioids include all opiates and opiate-based drugs that have additional synthesized and chemically altered drugs to attain varying degrees of analgesic strengths. Some examples of opioids are
These chemical compounds work by binding to receptors in the central nervous system- such as the brain and spine- that were meant to receive opioids produced naturally by the brain. While many of the processes involved are not fully understood, the general effect is that these receptors work to block or mute pain communication throughout the body. When suppressed with opiates, the body experiences considerably less pain.
Because opiates are so powerful and extremely habit-forming, chronic pain and opiate addiction are often directly associated with each other. However, the process of addiction occurs in stages and can be prevented or reduced with careful management. In order to understand this, it is important to differentiate between the varying levels of opiate dependency.
Opiate Addiction, Tolerance, and Dependence and The Differences Between Them
Unfortunately, nearly every person who takes opiate-derived drugs for more than a few weeks will develop a tolerance to the drug. This means that over time more and more of the drug is required to achieve the same effect. This is a natural process and it occurs with many types of drugs- not just opiates. It is a part of natural human evolution and adaptation as new substances and environments are introduced to daily life. As the human body becomes more adapted to having opiates, a physical dependence also begins to take hold. While some people with chronic pain may be able to avoid addiction, opiate dependence is unavoidable after taking the drugs for more than a couple of weeks. Opiate dependence is the body's physical adaptation to and subsequent dependence on opiates, and without them, an opiate patient will experience withdrawal symptoms like:
- body and muscle aches and spasms
- hugh fever
- cold sweats
- extreme fatigue
This physical withdrawal occurs because as tolerance levels to opiates increase, the body’s central nervous system changes in order to adapt to the constant supply of chemicals in the bloodstream. Essentially, the body attempts to curtail the effects of the opiates in order to return to a state of normalcy. However, these changes must be reversed when the drug is removed from the system, and that process can take from 3-10 days, depending on the severity and length of the opiate dependence.
Most any patient taking opiates for a long period of time will experience dependence and tolerance to the drugs. Because tolerance to opiates always grows when taken over a long period of time, requests to prescribing doctors for higher doses or strengths of these drugs can have the appearance of a drug seeking addict, rather than a patient in pain whose tolerance has grown naturally with the administration of opiates over time. And this is where doctors must practice vigilance in monitoring opiates prescribed and being on the lookout for some classic signs of drug-seeking behaviors. When the following behaviors are present in chronic pain patients, serious concern is warranted and addiction is highly likely:
- The patient shows a complete loss of control over the drug. They might take too much or not enough, not remember when their last or next dose is scheduled for, or experience changes in behavior or attitude as a result of losing control over the drugs.
- Addicted patients will demonstrate an inability to discontinue using the drugs despite significant consequences, such as the deterioration of health, relationship issues, legal troubles, financial difficulties, and increasing isolation from family and associates.
- Obsession with the drug rules the afflicted person’s life - they think about the drug constantly- how to get it, where to keep it, how and when to use it, how recovery from its effects can be managed, and how not to get caught using by family, associates, or authorities.
Often, a person addicted to opiates will understand and be able to articulate the fact that they are addicted, and may even be fully aware of the negative consequences as they occur, but may still be unable to discontinue using the drug. This is very different from tolerance or dependency, which both usually occur even in a well-managed pain treatment program. Although tolerance, dependency, and addiction in association to opiates and opioids represent unmanageability in some way, addiction stands alone in one glaring way. Addiction is the only condition of the three that kills, because unlike tolerance and dependency, addiction is a behavioral problem, riddled with self-destructive behaviors like:
- Obsessive behaviors
- Compulsive behaviors
There is a very fine line to walk with chronic pain patients and opiate use for pain control, but when addictive behaviors are present and co-occurring with chronic pain, doctors and patients alike are placed in a difficult situation.
Treatment Options For Chronic Pain Patients
Chronic pain and opiate addiction can happen to anyone, and when it does happen, addiction treatment is still necessary. A legitimate reason to take opiates doesn't give free passage to being, and behaving like an addict. There are many treatment centers which specialize in chronic pain addiction. Since addiction is a behavioral problem, complicated by varying degrees of change in brain chemistry, it is treatable and manageable with therapy, tools and support. In fact, there are thousands of individuals, organizations, and groups dedicated to providing chronic pain treatment services for those afflicted with an opiate addiction. Treatment can even continue to address both chronic pain and opiate addiction at the same time. Once a patient enters a treatment program for their opiate addiction:
- Opiate detoxification is the first step, in which the opiates are allowed to run out of the addict's system with medical supervision. Attempting to withdraw from opiates without medical supervision (cold turkey) can be dangerous, and possibly deadly.
- After about 3-10 days, physical dependency on opiates can be broken and more in-depth treatment can begin. This level of addiction treatment is not very different for chronic pain patients as opposed to addicts without pain. The goal is for every addict to understand why they abused drugs. Chronic pain addicts can be likened to food addicts who need food to live productively, but can not abuse it. For patients with pain, the specific goal is to understand and practice the lifestyle of chronic pain management without opiate addiction.
- Therapy is a main focus in addiction treatment and includes individual, group, and family sessions in order to include the loved ones of the afflicted person. A patient is also helped to make lifestyle changes that will decrease the likelihood of relapse. Recovering addicts are also provided with support and resources through continuing therapy and social groups such as Alcoholics Anonymousand Narcotics Anonymous, among others. Through group and individual therapy, chronic pain addicts will learn tools to keep their addictive behaviors behind them, and continue pain management without the unmanageability of addiction. In order to achieve this, it often requires another person possessing, dispensing, supervising the medication at all times. While there may be a deep desire on behalf of the addict to be free of addiction, willpower alone is often not enough to stay straight.
Chronic pain and opiate addiction is a serious issue, but is not one without hope. In fact, most people who consistently put forth the efforts required and adhere to their long-term treatment program will be in little danger of relapse. Health care professionals all over the country understand that chronic pain and opiate addiction are issues that can affect any person at any time, and therefore treatment is often compassionate, fair, and rigorous.
If you or someone you know has chronic pain and is also exhibiting signs of addiction, please call us at or fill out our free, confidential assessment form to have one of our trained, compassionate counselors help you choose the best path to recovery. We are here to help.