If you’re among the 50 million adults in the United States who are living with chronic pain — or pain that occurs nearly daily — you may have been prescribed one of a class of pain medications called opioids. And while there’s no denying that these drugs are powerful painkillers, experts aren’t convinced that opioids constitute an effective long-term treatment for pain. What’s more, people who take prescription opioids risk dangerous outcomes, including addiction and death.
Currently in the United States there is an epidemic of opioid addiction, and according to the Centers for Disease Control and Prevention, an average of 115 Americans die of an opioid overdose every day. Despite the prevalence of these pain medications, there are many misunderstandings about the drugs.
Here are six facts about opioid use in people with chronic pain.
1. Some people have an increased risk of developing a substance use disorder.
Genetics plays a major role in determining whether people will develop an addiction, says Dean Drosnes, MD, the associate medical director of Caron Treatment Centers Pennsylvania. For some people, an opioid addiction can develop in as little as three weeks; for others, the dependency may develop over years.
People with a family history of substance use disorders — including alcohol and amphetamine addictions — are most at risk, Dr. Drosnes says. Other people who may be prone to misuse opioids include those with mental health problems such as depression, anxiety, and post-traumatic stress disorder (PTSD).
Substance use disorder, says Drosnes, “is really a brain disease.”
2. Many people who develop physical dependence on opioids aren’t using the drugs recreationally.
People who are prescribed an opioid to relieve chronic pain often develop a “tolerance” to the drug — meaning that over time, their medication becomes less effective and they need to take increasingly higher doses to dull their pain, deepening their dependence. “A drug doesn’t have to be enjoyable,” says Drosnes, “for people to develop a tolerance to it.”
Other people — particularly those who have been taking opioids for at least a few weeks — will experience withdrawal symptoms like nausea, vomiting, cramps, difficulty sleeping, and an increase in pain after they stop using the medication. The latter symptom is particularly problematic for people with chronic pain, says Drosnes. “They feel that their pain is unbearable,” he says, “so they say, ‘I’d better stay on my medicine,’ when [in reality] the pain is increased in part because of their withdrawal.”
3. Most people feel less pain after they’ve weaned themselves off prescription painkillers.
It sounds counterintuitive, but over time, opioids can cause a type of heightened pain response known as hyperalgesia. Says Drosnes, “Multiple studies have shown that when people are exposed to [an uncomfortable task] like putting their hand in cold water, those who are on opioids have a lower pain tolerance than people who aren’t taking opioids.”
Opioids can also cause allodynia, or pain that’s felt even from a light touch, Drosnes says, like a wool sweater rubbing on your skin.
The good news is that these effects start to wear off within three to six weeks after the last dose of opioids is taken, Drosnes says. “It’s rare that I see a patient who doesn’t tell me that their pain is better after going off the opioids.”
4. You may never be truly pain free.
If you have a chronic condition, like arthritis, you’ll almost certainly feel some pain in the future — and it’s important to accept that reality. “If your goal is to eliminate pain altogether, you’re setting yourself up for disappointment,” says Drosnes. “The goal is to reduce the pain until you can peacefully coexist with it.”
But that doesn’t mean you have to suffer. “If I ask someone what their average level of pain is on a scale of 1 to 10, they may say 7 or 8,” says Drosnes. “And when I ask them what they want their pain to be, they almost always say 0. But when they think about it again, they say, ‘I can live with a 2 or 3.’”
And nonaddictive painkillers can be used instead of opioids; these include nonsteroidal anti-inflammatories (NSAIDs), certain antidepressants and antiseizure medications, and topical anesthetics, according to Drosnes. He also recommends alternative treatments like acupuncture, yoga, physical therapy, and meditation. “Nonpharmacologic treatments work really well [for pain management],” he says. “They’re safe, they’re effective, and they contribute to people’s overall wellness even after many years of continuous use.”
5. There’s a relatively high risk of relapse.
Generally speaking, people in recovery from opioid addiction should use those medications again only as a last resort, says Drosnes. That’s because the groundwork for relapse, so to speak, has already been established and reexposure to an addictive substance could trigger another substance use disorder.
“Once a person develops a substance use disorder, certain circuits in the brain become connected to each other,” Drosnes explains. “When [the person] stops using the substance, the connection weakens, but it never goes back to normal. So when the person is reexposed to opioids, those pathways in the brain fire up [again] really quickly.”
Other substances — even those that are less addictive than opioids, such as marijuana and hallucinogens — also have the potential to trigger a relapse in a person who’s recovering from opioid use disorder, says Drosnes. “If you had an opioid use disorder and you start using marijuana, you’re at [an increased] risk for developing a cannabis use disorder, often referred to as an addiction to marijuana,” he says. “Alcohol is the same way. You may never have been much of a drinker before, but because of these established pathways in the brain, you are at a much higher risk for developing an addiction to alcohol.”
6. Help is available.
People with chronic pain and substance use disorders can be treated at an inpatient center like Caron, which employs physicians, psychologists, and physical therapists who have experience in treating substance use disorders. Each patient is given an individualized treatment plan, which usually involves a gradual detoxification of opioids, psychological and spiritual counseling, physical therapy, and complementary and alternative medicine therapies.
“Addiction is a chronic disease,” says Drosnes, “and like many other chronic diseases, it needs to be managed as such.”
If you suspect that your loved one has a substance abuse disorder, contact Caron to determine whether he or she needs treatment. The facility can be valuable resource for overcoming opioid addiction while also treating chronic pain.
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