Addiction, Chronic Pain and Pain Disorder

What is Chronic Pain?

Chronic Pain and Addiction

Pain is best described as the body's signal to an individual that tissue damage has occurred or may be occurring. Pain can be acute, lasting for a shorter time, or chronic (long-lasting).  The timeframe for pain may be as brief as seconds or as long as a few weeks. Chronic pain, however, is defined as pain that lasts beyond the healing of an injury, continues for a period of several months or longer, or occurs frequently for months on end.

To develop the most accurate diagnosis and effective treatment, healthcare professionals also classify pain based on its characteristics, its cause, and the psychological and somatic mechanisms that are involved in sustaining the pain. During this process, a person's pain usually falls into several categories which are referred to as "nociceptive", "neuropathic", and "psychogenic."

Types of Pain

1. Nociceptive Pain:
   Nociceptive pain is believed to be caused by the ongoing activation of pain receptors in either the surface or deep tissues of the body. Two types of nociceptive pain have been identified:
   
   Somatic Pain
   Somatic Pain is generally caused by an injury to the skin, muscle, bone, joint, or connective tissues. Deep somatic pain is usually experienced as either dull or aching and described as localized in one area. Somatic pain can often involve the inflammation of injured tissue. Inflammation is a normal bodily response to injury and is considered essential for the healing process to take place. However, inflammation that does not disappear within a reasonable period of time can result in a chronic and painful disease. Somatic pain can occur within some organs as long as it is not associated with nerve damage.
   
   
   There are many different types of pain, each one with its own classifications. The type of pain should be a determining factor in prescribing medication. It should be noted: narcotics should be used as a last resort.
    
   Visceral Pain
   Visceral pain originates from an ongoing injury to an internal organ or the tissues that support the organ. When the injured tissue is a hollow structure of smooth muscle, such as the stomach, the pain is often diffuse (not in one spot) with painful cramping. When the injured structure is not a hollow organ, such as the liver, the pain may be pressure-like, deep and stabbing, and possibly easier to recognize.
    
2. Neuropathic Pain:
   Neuropathic pain is believed to be caused by modifications found in the central nervous system that sustain pain even after an injury heals. In most cases, the injury that initiates the pain involves the peripheral nerves or the central nervous system itself. It can be associated with trauma or with many different types of disease. There are a number of neuropathic pain syndromes, including diabetic neuropathy, trigeminal neuralgia, post herpetic neuralgia ("shingles"), post-stroke pain, and complex regional pain. Neuropathic pain is often described as a strange pain, with electricity running through the area or a burning sensation.
    
3. Psychogenic Pain:
   Chronic pain can be linked to a degree of emotional upheaval. Depression or anxiety, for example, can create situations that are difficult. Emotional distress may be a consequence of pain (an injured leg), or it may contribute to the pain itself (stomach pain from anxiety). Psychogenic pain is usually results from a person's psychological problems.

An individual with chronic pain has several alternative therapies that can be utilized, before relying on narcotic medications for chronic pain treatment. Physical therapy, a TENS unit, over-the-counter pain medications, local anesthetic injections, biofeedback, hypnosis, muscle relaxants, or surgery should be explored.

When alternative means have failed to adequately relieve the pain, a physician may prescribe opioids.  However, some physicians frequently use opiate medications as the first line of treatment for chronic pain. Opiate medications should always be the last resort as they are rapidly addictive and leave the chronic pain sufferer with an addiction to handle.  Addiction will ensure that harmful drug use continues with its resultant social, medical, legal, and psychological consequences, even after the pain has been relieved. Prescription drug detox supervised by medical doctors will be the only course of action to safely discontinue these pain medications.

It is important to note that the use of opioids opioid and opiate medications should be the last option for a physician. The following is list of some of the medications prescribed to treat chronic pain.

• Methadone
• OxyContin
• Hydrocodone
• Codeine
• Vicodin
• Percodan
• Percocet
• Dilaudid
• Lorcet
• Fentanyl

These medications are rarely taken alone. They are usually taken in conjunction with aspirin, anti-inflammatory drugs, antidepressants, muscle relaxers and other medications.  Sometimes, patients mix these medications with benzodiazepines, cocaine, marijuana, or alcohol, in a futile attempt to feel better psychologically and physically.  The outcome is continued chronic pain and addiction.

Do not discontinue the use of pain medications for chronic pain without first consulting your physician or contacting one of many addiction treatment centers specializing in the detox of prescription medications.

Pain Disorder

Pain disorder is associated with both psychological factors and a general medical condition. The pain causes clinically significant distress or impairment in social, occupational or other areas of daily function. Research has shown that more than 50 million Americans suffer from chronic pain associated with pain disorder. Joint pain, back pain, and headaches appear to be the most common cases of chronic pain. Other types of chronic are some neurologic diseases, as well as chronic pain secondary to traumatic nerve injury. . Physical chronic pain will have a negative impact on an individual psychologically, exacerbating the symptoms of pain disorder.  One example is fibromyalgia, which has a psychiatric and psychological component as well as a physical component and is another common cause of chronic pain.

50 million Americans suffer from various types of chronic pain associated with pain disorder. Treatment for chronic pain happens most often in pain clinic settings. Pain clinics treat the symptoms of pain, rather than the source of the pain. Hence, chronic pain sufferers will inevitably develop tolerance to taking medications. Their body will become acclimated to having certain pain medications on a regular basis and withdrawal will take place in the absence of those particular pain medications.

The term addiction refers to the physical and psychological adjustment that happens to an individual who takes opioid and/or opiate medications. Active addiction to substances, whether taken as prescribed or not, can actually worsen, rather than relieve, chronic pain symptoms. The use of addictive medications to treat chronic pain can result in worsened chronic pain and addiction.

Addiction and Pain Clinics

Pain clinics are doctor’s offices that specialize in the management of chronic pain and pain disorders with the use of prescription medications. Pain clinics offer medication management, physical therapy and mental health counseling as part of their regiment. In addition to these services, a pain clinic should also monitor medication levels through blood tests and urine tests and have a contract between the clinic and patient regarding medication compliance.  

Pain clinics that dispense medications without offering additional services, as stated above, are operating unethically. Many addicts take advantage of this type of pain clinic by going to several different clinics to obtain prescriptions for drugs. This behavior pattern is referred to as doctor shopping and can be extremely dangerous. Some pain clinics are cash only clinics, eliminating quality control by insurance companies. These types of pain clinics are often refered to as pill mills and these doctors are operating outside of the Hippocratic Oath.

Drug and Alcohol Addiction and Chronic Pain

Opioid and opiate  medications are the most readily prescribed drugs to treat chronic pain.  Physiological addiction develops whether the medication is taken as prescribed or abused.

Addiction to opioid and opiate drugs are defined by the American Pain Societyas a pattern of compulsive drug use characterized by a continued craving for an opiate/opioid and the need to use the opiate/opioid for effects other than pain relief. Addiction is characterized by the presence of:

• Loss of control or compulsive drug use
• Continual drug use in spite of adverse consequences
• An obsession or preoccupation with obtaining and using the drug

As a person's addiction progresses, life becomes more and more unmanageable. The body's tolerance for the drug grows requiring ever increasing amounts to achieve the same effect. The acquisition and use of drugs is the addict's number one priority. Relationships with loved ones deteriorate, work is missed, and the person is less productive. The progression is defined by a noticeable decline in social activities.

In many cases, the person with chronic pain suffers from some form of depression, as his or her quality of life continues to deteriorate. Many people fear that the only solution to relieve their chronic pain lies in taking opiates or medication for chronic pain treatment.  When a patient with chronic pain is anxious or has difficulty sleeping, pain symptoms are likely to be aggravated.

Sometimes, individuals will use cocaine, alcohol, marijuana, or other non-prescription substances in an attempt to alleviate symptoms such as anxiety or depression caused by chronic pain.  However, the use of these substances will likely lead to a never-ending cycle of addiction.  Through this cycle, the pain worsens, mental health symptoms worsen, and the drug addiction worsens.

Many health care professionals are now recognizing that the treatment of chronic pain is complex and multidimensional. Patients dealing with chronic pain require a careful evaluation and a treatment strategy that may incorporate a variety of distinct modalities. These modalities include acupuncture, meditation, chiropractic, and physical therapy.

Chronic Pain and Addiction Treatment

Quality addiction treatment centers will provide intensive counseling and psychiatric services in order to assist patients with medication management and medication or substance dependence issues.  Simultaneously providing these services is paramount to recovery from co-existing chronic pain and addiction. There are a variety of non-addictive prescription medications available that can help control chronic pain.  These medications should be prescribed by a physician familiar with their use.

A person who has developed a physical dependence to drugs will experience symptoms of withdrawal if the drug is abruptly discontinued. Even if a person is taking the medication as prescribed, taking opiates over a continuous period of time will result in a physical dependence. This does not necessarily mean the person is addicted, but it does mean that they will require an opiate detox.

Patients who use opiates to treat chronic pain usually do so for a prolonged period of time. Because of this, drug dependency can easily develop. Abrupt discontinuation of opiate use will trigger opiate withdrawal symptoms. The good news is that under proper medical supervision the symptoms associated with opiate withdrawal are manageable and can be greatly reduced.

Treatment of chronic pain and addiction, alcoholism and mental health problems needs to be provided in a controlled inpatient setting that offers a team of medical and clinical specialists (rather than just counseling). In addition to medical and psychiatric care, the patient will be provided with the emotional support and counseling required for a full recovery.

Related Content:

• Chronic Pain, Anxiety, Depression and Prescription Drug Addiction
  Chronic pain can produce anxiety and depression. Painkillers, even if prescribed, can be addictive.

Abruptly discontinuing the use of prescription medication or opiates for chronic pain could be life threatening depending upon the substances that you are using. Always contact your treating physician or one of many addiction treatment centers before you make this decision.  Recovery Connection is available 24 hours a day, 7 days a week to answer your questions at .