I don’t believe there are any simple solutions for addicts who present with chronic pain issues. As an inpatient therapist, I encountered several addicts who suffered from chronic pain related to previous injuries and/or surgeries. For many the addiction began around an opiate prescription intended to provide relief. This continues to be a huge problem today and the Surgeon General recently sent letters to more than 2.3 million health care practitioners challenging them to be more responsible in prescribing opiates and to screen patients for possible addiction. Some authorities are suggesting we are in the midst of an “opiate epidemic”. Opiate overdoses have risen 200% since 2000 and over 25,000 people died in 2014.
Prescribing opiates for pain is common practice and today we are dealing with a generation of “created addicts.” Not only have recent studies shown low efficacy in treating pain with opioids. New research shows that opiates may actually produce a paradoxical effect in the body called opioid-induced hyperalgesia in which the body becomes more sensitive to pain through opiate use. Tightening laws around the prescription of traditional opiates such as Hydrocodone, Codeine and OxyContin seems to only have exacerbated the problem. Opiate addicts continue to turn to Heroin or Fentanyl in order to try and obtain a lower cost “fix”. Regardless of what “flavor” an addict uses the problem of tolerance and a need for increased dosages to deliver diminishing returns is the same.
My belief is that a solution involves multiple interventions which address physical, mental and emotional aspects of pain management. I am a big fan of Dr. John Sarno who has written such books as “The Mind Body Prescription” and “The Divided Mind”. In his books, Dr. Sarno identifies an epidemic of back pain related to what he termed TMS-Tension Myositis Syndrome. The gist of this is that unresolved emotions create tension in the body and manifest as physical pain. I am not suggesting that chronic pain issues are somatic. However, the effects of stress and anxiety on the body are well documented. Learning relaxation techniques can be helpful in reducing tension and related pain. Physical interventions such as yoga, weight lifting and stretching can also be extremely beneficial. Physical activity may seem counter-intuitive to some and a physician should definitely be consulted. Exercise not only releases endorphins (natural pain killers), but can also build a stronger core and muscles. Inactivity atrophies the muscles which can exacerbate the pain.
I am not a medical doctor and will only touch on possibilities for non-opioid pain medicines. Some antidepressants, anti-inflammatory drugs and anticonvulsants have shown some efficacy in treating chronic pain. More controversial solutions such as Kratom are gaining public support and there are a variety of holistic plant and herb remedies. And of course there are ibuprofen, aspirin and acetaminophen.
I have a lot of empathy for those struggling with chronic pain. I broke a collar bone and ribs a couple years ago and it was extremely painful. The ER doctor offered me a script of Hydrocodone, but I declined having treated way too many opiate addicts. I managed the pain with a combination of Ibuprofen and Lidocaine patches. I also practiced relaxation techniques and began rehab as soon as the bones were secure.
A multidisciplinary approach may seem complicated, but so is chronic pain. We live in a culture that tends to perpetuate quick fixes. The pharmaceutical industry promotes this idea and frankly capitalizes on it. I am not a conspiracy theorist, but it doesn’t take a genius to figure out that a multi-billion dollar industry which makes money on what Chris Rock calls “the come-back” may not have public health as its top priority. There are some very good pain-management doctors and clinics out there. However, I would be very skeptical of anyone promising an easy cure.