Chronic Pain and Medication Dependence

After a tragic accident, many individuals are in a great deal of pain. Sometimes this pain is short-lived or can be easily relieved, but often, the pain is chronic. If you have been disabled due to the negligence of another, it is likely that you are experiencing chronic pain. Chronic pain is defined as any pain lasting more than 12 weeks. Chronic pain is different from acute pain, and often persists for months or even years.

Dealing with chronic pain can be very difficult. Because no one wants to live in a constant state of pain, doctors will often prescribe medications to help alleviate suffering. While prescription medications can be extremely effective and helpful in the treatment of pain, you should be wary before beginning to take any new prescribed drugs. Most prescription painkillers are very potent, and can become addictive very quickly. While we cannot give medical advice in this blog, we wish to discuss some of the potential negative situations that can arise when a patient becomes too reliant on narcotics.

Table of Contents

Understanding pain medications

Powerful prescription painkillers, commonly called “narcotics” or “opioid analgesics,” contain strong chemicals like morphine and codeine. Opioids occur naturally in poppy juice, and are also synthetically made in labs. Proteins called opioid receptors are found in the brain, spinal cord, and gastrointestinal tract. Painkillers that contain opioids attach to these proteins and block the transmission of pain messages to the brain. It takes a strong drug to inhibit the transmission of pain messages, which is why not everyone is able to physically handle the effects of opioids.

The opioid debate

Opioids can only be legally obtained through a prescription written by a doctor. These high-impact medications have the potential to cause drug tolerance, physical dependence, addiction, and abuse from their users. In addition to causing these conditions, painkillers can also bring with them serious and dangerous side effects. Common side effects of opioids include nausea and vomiting, constipation, sedation and fatigue, dizziness, rash and itching, cognitive impairment, respiratory depression, and urinary retention.

Because these medications are powerful and highly-addictive, their use is often very controversial. The United States Drug Enforcement Agency (DEA) classifies all controlled substances into five rankings, or “schedules.” The classification goes as follows:

Schedule I: Drugs, substances, and chemicals that are not suitable for medical use. Schedule I drugs have a high potential for abuse and addiction, and are the most dangerous drugs in existence. Schedule I drugs include street drugs like LSD, heroin, and ecstasy.

Schedule II: Drugs, substances, and chemicals with a high potential for abuse and the potential to also cause severe dependence. These drugs are less lethal than Schedule I drugs, but are still considered highly dangerous. Cocaine, methadone, and methamphetamine are examples of Schedule II drugs.

Schedule III: Drugs, substances, and chemicals that have a low to moderate potential for dependence. These drugs are much more commonly prescribed, and include Tylenol with codeine, anabolic steroids, and ketamine.

Schedule IV: Drugs, substances, and chemicals with a low potential for abuse and a low risk of dependence. Schedule IV drugs include Valium, Ativan, and Ambien.

Schedule V: Drugs, substances, and chemicals with the lowest potential for abuse and dependence. Schedule V drugs contain limited quantities of certain narcotics, and include Robitussin AC, Motofen, and Lyrica.

The progression of opioid use

When a patient uses narcotics to treat chronic pain, they are carefully monitored by a doctor. Before a doctor even prescribes the drugs, they should make sure the patient is well-aware of the risks and the side effects that accompany the medication. Many doctors will have patients sign an Opioid Treatment Contract, where the patient must agree to take the medication as prescribed and to meet with a doctor regularly for monitoring. Often, the patient is asked to agree to random urine and blood tests to verify that the correct dosage is being taken.

Doctors prescribe narcotics carefully because of the high risk of addiction associated with taking opioids. When patients take medications for prolonged periods of time—more than several weeks—addiction can become a large issue. Doctors need to be particularly cautious when working with patients who have a history of addiction or prescription abuse.

Physical dependence and tolerance

When a patient begins taking a medication, the risk for addiction and dependence is at its lowest. Because of the high potency of opioids, however, the body can develop a tolerance to them quickly. Tolerance occurs when, after a number of doses, a drug becomes less effective in managing pain and a patient requires a larger dose to experience the same level of pain relief. When a patient builds up tolerance to a medication, it is their doctor’s job to evaluate the situation and to decide how to proceed. Sometimes, pain is legitimately increasing in a patient—other times, however, the patient has simply become addicted to the drug.

When a patient becomes tolerant to a narcotic, they may also become physically dependent on the medication’s chemicals. Tolerance and dependence are both physical problems that bring physical side effects. When patients are dependent on a medication and do not wean themselves off of it slowly, withdrawal will occur. Signs of opioid withdrawal include:

yawning
enlarged pupils
increase in saliva and tears
goosebumps, tremors
inability to sleep
decreased appetite
vomiting, diarrhea
irritability
increased blood pressure
muscle cramps
drug craving
mood swings

It is important to note that there is a difference between physical dependence and addiction/abuse. A person can become physically dependent on a drug without intentionally abusing the drug or being addicted to the point of being “unable” to live without it.

Addiction

Developing a narcotic addiction is more serious than developing a tolerance to or becoming physically dependent on a drug. Addictions lead to the compulsive use and compulsive craving of a substance—in this case, a painkiller—to alter a mood. A person who has become addicted to opioids cannot function normally without the drugs in their system, and they have typically stopped caring about the correct dosage. Patients who become addicted to narcotics put their lives at risk by taking in too much of a powerful drug. Individuals are addicted to a drug if they:

Lose control over the use of the medication
Compulsively use the medication
Crave the medication
Continue to use the medication despite the possibility of harm to themselves or to others

It is estimated that 20 percent of individuals who take narcotics for chronic pain become addicted to their pills—often without realizing it. As compared to a patient who uses pain medications appropriately, a patient who is addicted to pain medications:

Uses the medication more often than prescribed
Does not experience improved function or physical abilities on the drug
Continues to complain of intolerable pain and requests more medication without appropriate concern
Does not comply with their treatment plan
“Runs out” of the prescription early or “loses” the prescription often

Patients who have a history of substance addiction are at a much greater risk of becoming addicted to opioids. There are clear warning signs when a person becomes addicted to prescription drugs, however, it is often too late to stop the addiction by the time the warning signs are realized. Criteria for diagnosing an addiction to prescription drugs includes signs within patients who:

exhibit tolerance to the drug
cannot control their intake of the medication
spend a significant amount of time trying to obtain the medication
give up important responsibilities or activities because of medication use
continue to use the drug even after learning that the drug has caused a physical and psychological dependence

Individuals who suffer from chronic pain can become addicted to more than just prescription medications. Sometimes, pain victims will choose to self-medicate with dangerous amounts of alcohol and illicit drugs rather than turning to approved amounts of prescribed painkillers. This is a very unsafe choice, as alcohol and illegal drugs are highly-addictive and alter moods to the extreme. Working, driving, and interacting with others while under the influence of these substances can be life-threatening because your defenses are down and your senses are dulled. Those who turn to alcohol and drugs run the risk of overdosing to “control” their pain. In addition, individuals who are abusing drugs and alcohol will likely experience severe disruptions to their personal, professional, and public lives.

Abuse

When an individual uses a medication in a way or in an amount not approved by their doctor, they are abusing that medication. It is estimated that one-third of the U.S. population has used illicit drugs, and that 6 to 15 percent of the population has a form of substance-use disorder. All types of substances can be abused, and roughly 28 percent of controlled substances are abused.

It is very possible for an individual to abuse their own prescription drugs by taking more than recommended each day, by continuing to take the pills after they have been told to stop, or by sharing their prescribed pills with others who have not been prescribed the pills. Always consult your doctor before stopping or starting a medication intake.

Source: “Chronic Pain and the Family: A New Guide” by Julie K. Silver, M.D.