Pain management for people in addiction recovery has become a huge topic of concern due to the opioid epidemic in our nation.
Physicians are presented with challenges when people with substance abuse issues are experiencing pain. On the one hand, they do not want to over prescribe, or may not prescribe narcotics at all, for fear of the individual relapsing or even possibly overdosing. On the other hand, people in recovery are less likely to receive adequate pain relief management than those of the general population. This then puts them at risk for self-medicating their pain.
The American Psychiatric Association Task Force outlines the diagnostic criteria for substance dependence (addiction) in their Diagnostic and Statistical Manual of Mental Disorders as a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested in three or more of the following, occurring any time in a 12-month period:
- Tolerance as defined by the following:
- A need for increased amounts of the substance to achieve desired effect
- A markedly diminished effect with continued use of the same amount of the substance
- Withdrawal as manifested by either of the following:
- The characteristics of withdrawal syndrome for the particular substance
- The substance (or one closely related) continues to be taken to avoid withdrawal symptoms
- Substance is taken in larger amounts or for a longer period of time than intended
- A persistent desire or unsuccessful efforts to cut back on or control substance use
- Much time is spent on activities necessary to obtain the substance
- Important social, occupational, or recreational activities are given up due to substance use
- Substance use is continued despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused by the substance
Physicians following these guidelines of addiction can better treat their patients. For instances of acute pain (pain that comes on all of a sudden such as broken bones or pain from surgery), this is seen as a medical emergency and patients are treated the same with pain relief medications as those that have not suffered with substance abuse. The issues arise with those individuals that are experiencing chronic pain. Chronic pain is pain that persists despite the fact that the injury has healed. This type of pain can be caused by arthritis, nerve damage, chronic headaches, and is also seen in cancer patients.
For those in recovery that suffer with chronic pain, physicians seek different means to manage their pain. Although opioid medications are useful for quick short term pain relief, they are not useful for long term use with those that are in recovery as there is a high risk for addiction. Controlled release forms of opioids have less fluctuations in release of the medication in the body and may be used with those patients that are in recovery from substance abuse. Anther form of pain relief that can be used are topical medications. Topical medications should be tried before opioid medications. These are a safer route to manage pain. Lidocaine patches are as effective as naproxen for managing localized pain such as carpel tunnel and pain in small areas of the body.
Physicians that build a relationship of trust with their patients are better able to know them and have a better understanding of their addiction. Many people in recovery will suffer with pain instead of taking medications to help ease the pain for fear of becoming addicted, or “relapsing.” This is an extremely touchy situation. Other avenues as the ones mentioned above, and holistic treatments such as acupuncture can be tried to manage pain safely.
If you are in recovery from addiction and suffering with chronic pain, it is wise to research other ways to manage your pain. Opioids should be taken as a last resort.
Prince, Valerie. “Pain Management in Patients with Substance Use Disorders.”