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What is Chronic Pain?
There is no single definition of chronic pain. But pain that persists or recurs for three or more months and negatively impacts a person’s life is generally classified as “chronic.” Chronic pain can affect everything from your mental health to your personal and professional life.
You may find yourself unable to socialize with friends and loved ones as you once did. You may discover you can no longer engage in the physical activities and exercise you once enjoyed. Chronic pain can affect your sleep, your stamina, and even your cognition.
Your career may suffer and you may be left with little choice but to leave a job you love because your pain leaves you unable to fulfill your work obligations. It’s unsurprising, then, that chronic pain should be a leading cause of disability worldwide.
Left untreated or improperly treated, chronic pain can take a devastating toll. And as the losses mount, you may turn to substances to help you mask both your physical and your emotional pain.
Facts About Chronic Pain
In the U.S., a Centers for Disease Control study found that 24% of the adult population experienced chronic pain in 2023, and 8.5% of these people frequently needed to limit their work or other life activities due to pain.
Prescription opioids are commonly used to treat chronic pain. In 2023, around 38 opioid prescriptions per 100 people were written by physicians for treatment of chronic pain. Widely used opioid medications include hydrocodone, oxycodone, morphine, and fentanyl.
Unfortunately, using opioids to manage chronic pain carries a risk of addiction, particularly in individuals with a personal history of addiction or other risk factors.
How to Manage Chronic Pain
Chronic pain is typically managed using medications and therapies such as physical therapy, counseling, nutritional therapy, and holistic therapies.
Commonly used holistic therapies include acupuncture, massage, yoga, meditation, and mindfulness. Practicing a healthy lifestyle and reducing stress are also important for managing chronic pain.
In addition to prescription opioid pain medications, chronic pain management can include other medications. These include anti-inflammatory medications, steroids, muscle relaxers, pain blockers, and antidepressants.
When chronic pain is resistant to typical treatments, patients may be referred to specialized pain clinics.
Chronic Pain and Addiction
Many prescription opioid medications used to treat chronic pain are highly addictive. Hydrocodone is commonly sold as Vicodin. Oxycodone is marketed as OxyContin or Percocet. These, along with morphine, methadone, and prescription fentanyl are all central nervous system depressants.
These drugs provide pain relief and often produce feelings of euphoria. Patients can easily get used to these pleasant sensations and resist giving them up. They stay hooked even if the source of their pain is subsequently alleviated.
Tolerance and dependency then develop. Tolerance is when a person needs more opioids to get the same effect as time progresses, while dependency means the person requires the drug just to feel normal and will experience uncomfortable withdrawal symptoms without it.
Physical dependence can occur within 4 to 8 weeks of the induction of prescription opioids. The American Medical Association and Mayo Clinic estimate that up to 19% of people given opioids will go on to develop a chronic dependency.
Those who develop such a dependency sometimes obtain pills from friends or family members when their doctor will no longer provide a prescription pain reliever or will not increase the dosage. Some end up turning to street drugs. The National Institute on Drug Abuse reports that almost 80% of heroin users had used prescription opioids prior to using heroin.
Reducing the Risk of Addiction to Pain Medications
Those who are prescribed medication for chronic pain can still find ways to reduce the risk of becoming addicted. These include using general self-care activities, using counseling and behavioral therapies, and using topical and non-opioid pain-relieving treatments.
Self-care Activities
Self-care activities basically consist of treating your body in a healthy manner. It can be as basic as getting a good night’s sleep and eating a balanced diet to reduce inflammation and maintain a healthy weight.
Exercising is also part of self-care. For example, gentle yoga combined with meditation can ease pain and support your physical, mental, and emotional wellbeing.
Counseling and Behavioral Therapies
Cognitive behavioral therapy is helpful for those who want to reevaluate negative thoughts and beliefs that increase sensitivity to pain and also to learn new coping skills. CBT often coincides with formal group therapy, in which you’ll attend chronic pain and management classes or support groups.
In addition to talking out your problems, you can augment your therapy with some light exercise. Stretching, yoga, or Tai Chi can relax your mind. Practice deep breathing exercises or make an appointment for acupuncture or massage for chronic back pain.
Other “alternative” treatments can include hypnosis or signing up for chiropractic treatments to manage your pain.
Topical and Non-opioid Pain-relieving Treatments
Many people think of opioid medications when they want to manage their chronic pain. But even if you prefer medicines to yoga and exercise, you don’t have to fall back on powerful prescriptions.
Gels, ointments, or pain-relieving patches are readily available at pharmacies. You can also buy over-the-counter non-steroidal, anti-inflammatory drugs or NSAIDS, such as ibuprofen. Check with your doctor to see if antidepressants could help manage your pain through mechanisms like addressing nerve sensitivity or pain perception.
If you find that these options are working for you, you might consider working with your doctor to reduce your pain medication dosage. A tapering schedule can be effective to gradually reduce your prescription strengths.
How Do I Know if Someone Has an Addiction?
According to the New York State Office of Addiction Services and Supports, there are signs that can indicate an opioid dependence. The following are signs of an addiction that can be observed by family or friends:
Physical Signs
Your body may show evidence of an overdependence on opioids. Your pupil size may be reduced, or you may show flu-like symptoms. You may also appear drowsy. Appetite or weight loss are also typical signs of an addiction.
Behavioral Signs
In addition to physical changes, your behavior may also alter. Loved ones may notice a change in your attitude or personality, especially if you avoid contact with friends or family. Your behavior may become secretive as you prefer being isolated. People may describe you as moody or, conversely, with periodic bouts of unexplained giddiness.
Loved ones may also notice a loss of interest in your usual hobbies or normal activities. This includes a drop in performance at school or work. If they confront you about this behavior, you may become irritable.
Signs of Opioid Withdrawal
Those who are withdrawing from opioids may also show changes in their body and behavior. Withdrawal can lead you to become nauseous, with bouts of vomiting. The body may become sweaty or break out in goosebumps. Excessive yawning is another sign.
Behavioral changes also accompany withdrawal. Typically, people may become overly anxious.
Where Can I Find Information About Substance Abuse Treatment?
Information about substance abuse treatment is available at the Substance Abuse and Mental Health Services Administration website. SAMHSA offers free assistance to find addiction treatment and support services. They also have a free National Helpline at 1-800-662 HELP (4357). Calls are confidential and available 24/7/365.
You can also ask for referrals from your doctor or mental health therapist.
What Are the Treatment Options for Drug Addiction?
Options for treatment of drug addiction include detox, inpatient treatment, outpatient treatment, and aftercare.
Detox treatment focuses on stabilizing you after you stop using opioid medications. A number of different medications can be prescribed to help alleviate withdrawal symptoms. Detox services are available through inpatient care or outpatient care. Residential detox involves 24/7 inpatient care and supervision by a medical team.
Outpatient detox does not include 24-hour supervision. Clients attend scheduled meetings at a detox center or doctor’s office where they receive medication and monitoring.
After detox, you may be prescribed medically assisted treatment, or MAT, for long-term treatment of opioid addiction. MAT utilizes FDA-approved drugs like methadone, buprenorphine, and naltrexone, to help reduce cravings and decrease the risk of returning to using opioid pain pills.
Inpatient rehab is the most intensive form of treatment and requires overnight stays in a hospital, clinic, or drug rehab center. 24/7 supervision with medical care is provided. Along with detox services and medication management, inpatient treatment offers counseling sessions, addiction and relapse prevention education, and often in-house 12-Step meetings.
Additional options like holistic treatments, experiential therapies, and recreational activities may be available.
Outpatient treatment involves three options. Standard outpatient treatment programs include meetings at a rehab facility that last 3-4 hours per day for 3-4 days a week, over an average of ten weeks.
Treatments usually include group counseling and addiction and relapse prevention education. Often, 12 Step meetings are included as well. Outpatient medical treatment at a doctor’s office or specialized clinic is available, as well, and often includes MAT.
Intensive outpatient programs are more exhaustive and offer 9-30 hours of treatment over 3-5 days a week. They can last for several months up to a year.
Partial hospitalization programs provide the most intensive treatment that is available on an outpatient basis. PHP programs include all day sessions, usually held 4-5 days a week and lasting about 8-12 weeks. Both IOP and PHP programs usually provide individual and group counseling sessions.
Aftercare is continuing care that starts once a rehab program has ended. It provides ongoing support and resources to help prevent relapse. Aftercare often involves 12-Step meetings and alumni social events. Additional scheduled counseling sessions may be offered as needed. Aftercare can last several months to a year post-treatment.
