October 17th, 2022
We all understand pain. Maybe it was a cut or a broken bone. This acute pain is sudden and typically resolves in days or weeks. But, chronic pain can occur anywhere in the body and last for months or years. This intense and lasting pain creates a link between chronic pain and substance abuse.
What is Chronic Pain?
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Chronic pain is any persistent pain that lasts 12 weeks or more. Chronic pain often decreases mobility, changes appetite, increases stress sensitivity, mood swings, and other co-occurring mental health issues. Chronic pain can occur because of an injury or health conditions.
Chronic Pain from an Injury
Chronic pain from post-trauma (car accident, surgery, or other trauma) may appear in other areas. A person may also experience::
- Headaches
- Back pain
- Tingling
- Nerve pain
- Arthritis
- Joint pain
- Insomnia
- Depression or anxiety
- Difficulty breathing
Chronic Pain and Health Conditions
Chronic pain can be complex and difficult to treat. For example, fibromyalgia causes chronic fatigue, tenderness, and bone pain. However, it also affects a person’s mental health. Chronic pain is also a symptom of:
- Endometriosis
- Cancer
- Multiple sclerosis
- Neuralgias
- Inflammatory bowel disease
Chronic pain leads to people not moving around as much, muscle tension, appetite changes, and emotional struggles. Women, obese people, tobacco smokers, and those with an injury are at the highest risk of struggling with chronic pain.
Chronic Pain and Addiction
Chronic pain and substance use disorders have a complex relationship. This is particularly true with opioid misuse and addiction. An estimated 10 percent of chronic pain patients misuse their prescription opioids. Furthermore, the emotional struggles of chronic pain confuse the brain’s stress and reward circuits, increasing the risk of opioid use disorder.
According to the National Institute on Drug Abuse, 68,630 people died from opioid overdose. The high rates of chronic pain and addiction show the need for education, screening, and safety with opioid medications.
Tobacco Use and Chronic Pain
One of the biggest causes of co-occurring physical conditions is smoking cigarettes. It is linked to significant health conditions. Smoking is also the number one preventable cause of premature death and disease.
For example, most lung cancer and a third of all cancer deaths are linked to cigarettes. Smoking cigarettes contributes to health issues such as:
- Macular degeneration
- Diabetes
- Colorectal cancer
- Liver cancer
- Tuberculosis
- Erectile dysfunction
- Rheumatoid arthritis
- Inflammation
- Impaired immune system
People with chronic pain and substance abuse often smoke cigarettes, contributing to health problems. It is estimated that 77 and 93% of those in addiction treatment smoke cigarettes.
How Does Tobacco Worsen Chronic Pain?
The nicotine in tobacco triggers the release of dopamine, the feel-good chemical, which gives a satisfying sensation. This chemical release is why cigarettes are so addictive.
But tobacco also decreases the oxygen in the blood depriving bones and tissues of needed nutrients. This decrease in oxygen can cause degeneration, especially in the spine’s discs. This leads to back pain and sometimes osteoporosis.
Mental Illness, Chronic Pain, and Substance Abuse
Physical pain is the body’s way of saying something is wrong. So people go to the doctor for treatment. But, there is also a psychological aspect to pain. People with chronic pain have an increased risk of developing mood and anxiety disorders.
Chronic pain can lead to feelings of depression and hopelessness, anxiety about health issues, or an addiction to pain medication. Unfortunately, these can all worsen chronic pain.
Mental illness can both cause and worsen pain. Stress creates inflammation and muscle tension causing more pain. Sometimes people get caught in the cycle of chronic pain and mental distress as the two magnify each other.
Anxiety and Chronic Pain
The link between anxiety and chronic pain is complex. Chronic pain can encourage the onset and worsen anxiety. At the same time, anxiety can increase the development and aggravation of pain.
Depression and Chronic Pain
Chronic pain can interfere with all aspects of life, such as mobility, relationships, and careers. This can lead to co-occurring depression. Some research suggests up to 85 percent of people with chronic pain have co-occurring depression. Like anxiety, depression can result from and contribute to chronic pain.
What is Treatment Adherence?
Treatment adherence is the extent to which a person’s behavior corresponds with a doctor’s recommendations. These behaviors can include taking medications as prescribed, eating healthy, and other lifestyle changes. While lifestyle changes are essential for managing chronic pain, taking medications as prescribed is especially important for chronic pain patients.
Treating Chronic Pain With Medication
To help manage chronic pain, doctors typically prescribe opioids. However, opioids are highly addictive and not always effective in treating pain. The following opioids are most often prescribed for chronic pain.
Morphine
Morphine tablets are used to treat chronic moderate to severe pain. Extended-release capsules and tablets can treat severe pain requiring round-the-clock, long-term treatment. However, using morphine for a long time, even as directed, can be addictive.
Oxycodone
Oxycodone can relieve moderate to severe pain. Taking oxycodone for extended periods can lead to addiction. If you stop or lower your dose, it can cause withdrawal symptoms. Withdrawal symptoms can include:
- Cravings
- Anxiety
- Muscle aches
- Sleep disturbances
- Racing heart
- Nausea/ diarrhea
Fentanyl
Fentanyl is 50 to 100 times stronger than morphine. It is only prescribed for the severest of chronic pain because of its high potential for abuse and severe dependence. In 2020, over 56,000 people died from synthetic drugs, primarily those containing fentanyl.
Chronic Pain and Addiction to Painkillers
People with chronic pain start taking their painkillers as prescribed. But, some people begin taking more than prescribed to manage their pain or because they have built up a tolerance. Other people take more because they enjoy the euphoric effects of the medication.
The more people take, the higher the tolerance; before long, they have an addiction. It’s important to understand the signs of addiction and seek help. The symptoms of addiction include:
- Needing more to achieve the same effects
- Changes in personality, mood, and energy levels
- Isolating or withdrawing from family and friends
- Neglecting responsibilities
- Declining self-care
- Seeking illicit drugs
- Doctor-shopping
How Does Substance Use Affect Chronic Pain?
We are taught that a pill will make us feel better if we are in pain. And sometimes that is true. But did you know that taking opioids for four weeks or more can make you more sensitive to pain? It is even possible for them to stop working at all.
Opioids provide relief by blocking the pain. However, your body responds by increasing pain receptors to get the pain signal through. So, when the medication wears off, the pain is more intense. The longer a person takes opioids, the less effective they are, which increases chronic pain.
What is the Relationship Between Chronic Pain and Substance Abuse?
People with chronic pain never intend to develop an addiction. We know people who continue taking more than prescribed typically become addicted. But, people who take their medication as prescribed can also develop an addiction.
When painkillers are taken for an extended time, and a person needs higher doses to feel the same effects, they have developed a tolerance. Once a person needs that medication to feel normal, or they feel physically sick, they are dependent on that drug.
If a person is dependent on a medication and misses a dose or stops it, they often experience withdrawal symptoms. If a person does not seek help and continues using medications or illicit drugs, the dependency turns to addiction.
Treatment Options for Chronic Pain and Addiction
When medications for chronic pain turn into an addiction, a person’s treatment plan changes. Not only do they need new methods for treating chronic pain, they now have a substance use disorder to treat.
Chronic pain and addiction are typically treated with both therapies and medications. Therapies may include physical therapy to help with mobility. While opioids and other highly addictive medications can’t be taken anymore, there are medications that may help.
Non-Opioid Pain Medications for Chronic Pain and Substance Abuse
While not as strong as opioids, non-opioid drugs, in combination with other therapies, can help manage pain and maintain sobriety. Common medications include:
- Non-steroidal anti-inflammatory drugs including ibuprofen (Advil, Motrin) and naproxen (Aleve)
- Acetaminophen
- Beta-blockers
- Anticonvulsants such as gabapentin
- Antidepressants
- Synthetic Marijuana
Therapies for Chronic Pain and Addiction
Getting a person through detox is the first step in fighting chronic pain and substance abuse. Once the body has rid itself of the drugs, it is time to work on changing the behaviors of addiction caused by chronic pain.
Cognitive-behavioral therapy (CBT) is an effective alternative to opioids for chronic pain alone or in combination with non-opioid medications. CBT can change how people perceive and respond to chronic pain.
Cognitive-behavioral therapy is a form of talk therapy that helps people identify negative thoughts that make it harder to cope with physical and mental health issues. Commonly used to treat anxiety, depression, and substance use disorders, CBT combined with yoga and meditation can help manage pain without opioids.
Chronic Pain and Substance Abuse Treatment at Free By the Sea
Has managing your chronic pain led to struggling with an addiction to painkillers? We believe a holistic approach to treating chronic pain and substance abuse is the path to lasting recovery. We are waiting to answer your questions. Contact us today.
Dr. Richard Crabbe joined our team in 2019 as our psychiatrist and medical director. He attended the University of Ghana Medical School where he became a Medical Doctor in 1977. From 1978 through 1984, he was a medical officer in the Ghana Navy and provided a variety of services from general medicine to surgeries. He received his Certificate in General Psychology from the American Board of Psychology and Neurology in 2002.
