When Managing Chronic Pain Becomes Addiction


From back strains to sports injuries, chronic pain is surprisingly common. About 116 million Americans are estimated to struggle with chronic pain. While there are many ways to manage it, some individuals turn to drugs to relieve the discomfort. Unfortunately, this creates the potential for drug abuse and addiction and, ultimately, the need for drug rehab treatment.

Chronic Pain and Substance Abuse Connection

Although suffering from chronic pain is all too common, not everyone who experiences it will become addicted to the drugs used to treat it. Which factors make you more vulnerable to developing an addiction? Drug addiction is a complex problem with a range of risk factors, including having a family history of substance abuse and addiction. You’re also more likely to struggle with addiction if you have a mental health disorder, such as anxiety, depression or post-traumatic stress disorder (PTSD).

Chronic pain itself, however, makes some individuals more vulnerable to addiction. Pain is difficult to live with at any time, but when severe discomfort last for months or years, or, in some cases, is ever-present, it can take a serious physical toll, perhaps even limiting your ability to work. That has the potential to damage your self-esteem, especially if you feel you no longer have something to offer your family, your workplace or society.

Dealing with long-term pain also generates negative feelings. It’s easy to become frustrated with family members or co-workers who don’t understand your limitations, or to frequently feel angry because you live in chronic pain. Feelings of helplessness, which are often triggered by chronic pain, will impact your emotional well-being as well. It’s frustrating to live with a condition for which you can’t find relief. Living under the constant weight of these emotions creates a higher risk for depression, which itself is a risk factor for addiction.

Chronic Pain and Painkiller Addiction

One common way to treat pain is through the use of prescription painkillers. Opioids, such as Vicodin, OxyContin and Percocet, belong to the same class of drugs as morphine and heroin. These drugs affect specific parts of the brain to reduce the perception of pain. Opioids flood the brain with high levels of dopamine, a neurotransmitter that creates a “feel-good” sensation.

Many patients are able to take prescription painkillers without becoming addicted. In some, opioid drugs generate negative side effects, such as dizziness or nausea, making them unwilling to use the drugs long-term. Some individuals, however, are so desperate for relief that they don’t follow the prescribed dosage. Instead, they take larger doses or take the medication more frequently. Unfortunately, a tolerance often develops. When that occurs, increasing amounts of the medication are needed to get the same benefits. Others begin to crave the euphoric feeling that narcotics can provide, leading to ever-increasing doses as tolerance progresses. Before long, a full-blown addiction has developed.

There’s no way to predict which prescription painkiller a user will become addicted to. However, some individuals have a greater risk for becoming addicted than others. Addiction risk factors include having a family history of addiction, living with a mental health disorder, such as depression or anxiety, or experiencing a past trauma, such as physical or sexual abuse. Those who have struggled with previous substance abuse are more vulnerable to painkiller addiction as well.

Another dangerous aspect of painkiller addiction is that the next step may be heroin use. Health officials say this isn’t uncommon. Prescription painkillers are more expensive and more difficult to obtain than heroin. In addition, some prescription drug abusers find that their insurance plans stop paying for the medication, so they seek relief elsewhere. Any of these factors have the potential to drive individuals from prescription drugs to heroin. In fact, one 2011 study found that 80 percent of heroin users had previously misused opioid prescription painkillers.

Chronic Pain and Other Substances

Opioids aren’t the only substances that lead to addiction in chronic pain patients. For example, in one study, 28 percent of participants reported using alcohol for pain relief. Alcohol abuse and alcoholism raise their own serious concerns for health and well-being, but those concerns increase when a person combines alcohol with pain medications. Mixing alcohol with acetaminophen, for example, raises the risk for liver failure. Combining alcohol with opioids increases sedation, leading to a risk of drug overdose.

Some chronic pain patients turn to marijuana to relieve their symptoms. Recently, several more states have moved to legalize medical marijuana, yet there are still concerns about the drug’s addictive potential. Although it’s not considered as addictive as other substances, including prescription painkillers, it does carry the potential for abuse and addiction. About 18 percent of individuals entering drug rehab treatment reported that marijuana was their primary drug.

Warning Signs of Addiction

It’s important to understand the warning signs of addiction.  They include:

  • Requiring increasingly larger doses to achieve the same effect
  • Seeking prescriptions from multiple physicians (also called “doctor shopping”)
  • Changes in personality, including mood or energy levels
  • Withdrawing from family and friends
  • Neglecting responsibilities, including work and household chores
  • Becoming defensive when a loved one brings up the potential problem
  • Deteriorating appearance and declining personal hygiene habits

Treating Addiction and Chronic Pain

Addiction to prescription painkillers, heroin or other drugs is potentially life-threatening. If you or someone you love is addicted, seek professional help. If you’re addicted to opioids or alcohol, you’ll need medically monitored detoxification. After detox, you will begin an outpatient or residential treatment plan tailored to address your specific needs. Addiction counseling will help you develop the skills needed to cope with negative emotions, like anger or loneliness, without relying on a substance.

However, if you’re still genuinely experiencing chronic physical pain, it’s essential to address that concern as well. If pain remains untreated, it creates a serious potential for relapse. Pain management will likely focus on nondrug strategies. For example, regular exercise triggers the release of pain-relieving endorphins, while dietary changes may reduce pain in patients with problems caused by chronic inflammation. Alternative therapies, such as meditation, acupuncture and massage therapy, reduce discomfort as well. In a few cases, pain medication may be medically necessary, so the rehab staff will help you build the coping skills needed to avoid drug abuse and relapse.

If you’re worried that you’ve developed an addiction related to chronic pain, it’s time to seek professional help. A drug rehab treatment program will develop a recovery plan for you that addresses your addiction as well as your chronic pain so that you can begin the process of healing and reclaim your life.

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