In an ongoing struggle, healthcare providers are trying to find the best methods to help people who deal with chronic pain. There are an estimated 116 million people in the U.S. alone who are faced with the issue of chronic pain. And in 2014, pharmacies in the U.S. dispensed 245 million prescriptions for opioid pain relieving medication. While a majority of the opioid medications dispensed were for acute pain events, between three and four percent were dispensed for adults with longer-term opioid pain management therapy.
One of the problems faced by healthcare providers is that, when prescribing pain medications for those who are in pain over a long period of time, the patients often develop a tolerance for the medications. In other words, they need increased doses in order to achieve the same pain-relieving effects. Tolerance can occur after a single dose of the medication or can occur more slowly. Patients may even need up to ten times the dosage of their original prescription to achieve the same result.
Additionally, patients can also develop a condition known as hyperalgesia, which means that they become increasingly sensitive to pain. If hyperalgesia does occur, it can lead to increases in pain medication use that are not appropriate. Because of the nature of the condition of hyperalgesia, the pain will increase. The best manner of handling the condition of hyperalgesia is to gradually decrease and eventually discontinue the use of the opioids.
The difficulty with hyperalgesia is that it is often difficult to diagnose. One indicator that the patient has developed hyperalgesia, rather than a tolerance, is that with an increase in the medication, a patient who is developing a tolerance will have symptoms that are stabilized, and a patient experiencing hyperalgesia will have short-lived pain relief. Hyperalgesia is often exhibited by pain that spreads to other areas of the body where the patient didn’t previously experience any pain.
One of the most serious complications of prescribing pain medication for long-term use is that patients can become addicted to the medications. Drug addiction and chronic pain may seem like an unlikely combination, especially if someone is receiving their pain medications from a physician who is prescribing them, but it happens often.
Some of the signs for dependency on pain medications include:
- increased usage
- personality changes
- use of the medications past the time when a condition or injury has healed
- withdrawal from family, friends or social situations
- spending more time getting prescriptions and visiting various doctors to obtain them
- neglecting household and work responsibilities
- experiencing blackouts and other episodes of forgetfulness
- exhibiting an increased sensitivity to sounds that don’t normally bother others
- becoming defensive when others talk with them about the possibility of dependency.
A major problem with dependency on opioid medications is that it is a disease that may affect anyone — even those who are the most careful about taking their medications according to their physician’s orders. That is why it’s very important to watch for the signs and symptoms of dependency and address them.
The great potential for dependency when prescribing opioid medications is one of the reasons why physicians need to be extra in monitoring patients for whom they are prescribing pain medications for chronic pain. Factors that may influence the likelihood of addiction include a family history of drug addiction or abuse, as well as severe behavioral health issues such as post-traumatic stress disorder, depression or anxiety. Physicians should ensure that they are monitoring the number of refills that the patients are receiving, and whether the patients are repeatedly asking for an increase in the dosage or refills prior to the expiration of the current prescription.
Physicians prescribing opioid medications for chronic pain need to be aware not only of the effects of the medications on their patients, but also of the effects of chronic pain itself. Chronic pain may lead to depression, as those who experience chronic pain may be unable to work and could lose their sense of self-esteem. The negative feelings associated with depression can also be complicated with anger because the person experiencing chronic pain may no longer be able to enjoy life as they once could.
The depression associated with chronic pain may make the patient more susceptible to abuse of opioids, especially if they are feeling a sense of well-being when taking the opioid for pain relief. Physicians may be able to combat a patient’s depression with anti-depression medication, thereby possibly curbing the patient’s need to seek more opioid medication.
Fortunately, researchers are looking for alternative ways to treat chronic pain other than with prescription medications. With the increased number of the elderly population in the U.S., as well as the number of military personnel who have suffered severe injuries, it’s very important that this research continue with an intensified effort.
How Addiction to Pain Killers Can Lead to Heroin Abuse
Painkillers such as OxyContin belong to the same class of drugs as heroin. They are both opioids and work in a specific manner. After attaching to opioid receptors in the body, these drugs are able to lessen the feeling of pain. In addition to lessening the feeling of pain, these drugs also cause a certain euphoria and relaxation, which can lead people to abuse them.
However, opioids also have a number of negative effects, including opioid-induced constipation and drowsiness, as well as suppressed breathing if taken in large amounts. If taken in too-large amounts, opioids can suppress breathing to the point that the user can die.
As physicians are more closely monitoring opioid-based painkillers, they are becoming more difficult to obtain. States have also stepped in with legislation that makes it more difficult for people to get these painkillers by enlisting the aid of pharmacists or doctor shopping (when patients acquire multiple prescriptions from different doctors).
When it becomes too difficult for someone to obtain a prescription opioid they have developed a dependence on, it is not uncommon for that user to turn to heroin. Chronic pain and heroin addiction are becoming an all-to-common combination. Not only is heroin cheaper than prescription opioids, but it’s also easier to obtain. Because of the addictive nature of opioids, those who turn from prescription opioids to heroin have likely become addicted to opioids to the point where they will stop at nothing to get their next fix.
It doesn’t matter if they need to steal money or miss work in order to obtain the drug — the chemical change that opioids cause in their bodies and brains has interfered with their rational thought, as well as their ability to use restraint and good judgment when deciding how to get more heroin.
The statistics are stunning: 80% of the pain medicine in the world is used by those in the U.S. alone. Drug overdose has become the top cause of American deaths of an unintentional nature. And every 19 minutes, someone dies from overdosing on a drug, which makes death from a drug overdose more prevalent than deaths from car accidents.
As of 2012, approximately half of the 40,000 drug overdoses were related to pharmaceutical medications. And over 70% of those deaths involved the use of opioids.
Physicians are doing their part to try to reduce the number of drug-related deaths. In Florida, drug overdose deaths have decreased because there have been greater restrictions on those who prescribe painkillers.
Now, pharmaceutical companies are joining the efforts to reduce drug overdose deaths. A new type of OxyContin was introduced in 2010, making it less likely to be crushed or made into a soluble form and more difficult to be abused by injection or snorting. The abuse of OxyContin decreased from over 35% in 2010 to a little less than 13% in 2012.
Though the new laws resulted in less abuse of prescription opioids, the problem is that one of the unintended consequences of the crackdown on the abuse of prescriptions opioids has resulted in an increased use of heroin. Heroin use was shown to have doubled in the same period of time during which the abuse of OxyContin decreased.
Today’s Heroin Addict
The heroin addict of the 21st century isn’t the same as the heroin addicts from two or three decades ago. It used to be that most drug users escalated from other illegal drugs to heroin. But now, addicts start with the use of prescription opiates and then graduate to heroin when they find they can no longer obtain enough prescription opiates to satisfy their high. Today, people will switch back and forth between heroin and prescription opiates.
The number of people who reported using heroin in 2014 was twice as many as that in 2007, increasing to 620,000. Actor Philip Seymour Hoffman, who died in 2014 when he was only 46 years old, had quit using heroin two decades prior to his death. In the year preceding his death, he struggled with an addiction to painkillers. Painkillers such as Vicodin, OxyContin and oxycodone — all similar opiates which provide a chemical reaction like that of heroin — keep the craving current for recovering addicts.
No longer the drug of only large cities and street corners, the abuse of heroin has come to small-town America. The town of Hudson, Wisconsin, with a population of 13,000, was the site of seven heroin overdoses within an eight-month period in 2014.
Statistics are showing an increase in the use of heroin among younger and whiter populations, as well. In 2010, 88% of those who died from overdosing on heroin were white, half were younger than 34, and approximately one-fifth of them were between 15 and 24.
Part of the reason for these heroin deaths is that prescription opioids are becoming more difficult to get, and the new formulas of prescription pain killers have made them more difficult for people to abuse. Ironically, the increased efforts to stem the abuse of prescription painkillers are thought to be contributing factors in the increased use of heroin across the country.
Alternatives to Pain Medications
While it’s often difficult for physicians to break out of the traditional therapy of prescribing pain medications as the method of choice to address chronic pain for their, there are alternative therapies.
Acupuncture, a Chinese art, has been in existence for around 2,000 years. Acupuncture makes use of very thin needles, which are inserted into the skin in order to work with the meridian system of the body to treat pain. Though there are a number of studies that have proven that acupuncture is effective in treating pain, and the World Health Organization believes that pain is a condition that is treated by acupuncture, it’s not always an alternative therapy that is well-recognized by physicians.
Aromatherapy is another type of alternative medicine that is believed to be conducive to pain relief. This particular type of therapy goes back thousands of years, and was often use by the Greeks and Romans as part of their medical treatment. Studies have proven that there was a decrease in pain for those with a variety of conditions and/or diseases such as cancer, rheumatoid arthritis and headaches.
Though technically still considered an alternative type of medicine, chiropractic medicine seeks to examine how the body’s structure and alignment impact pain. The chiropractor will make a series of adjustments to the spine so that the body is in better alignment. Pain relief is often a result of the body being in better alignment, and chiropractic medicine has been shown to help relieve pain in the back and neck, as well as helping those with chronic headaches, carpal tunnel and injuries that are related to sports.
While the methods mentioned involve neither surgery nor medication, some physicians are reluctant to use them for a variety of reasons. They may not believe or be familiar with their effectiveness, and they know that insurance companies don’t often cover these treatments. While more insurance companies have started to cover a limited number of chiropractic treatments in recent years, most insurance companies don’t cover therapies such as acupuncture.
Hypnotherapy is another type of alternative medicine that may assist with pain management. This type of therapy is intended to enable people to achieve greater relaxation and have more control of both their body and symptoms of pain. Additionally, it can help reduce the anxiety that’s often associated with pain.
Massage, while it is therapeutic for purposes other than pain management, is a great tool for reducing pain. This type of therapy helps with circulation within muscles and bodily systems, including the lymphatic system and nervous system. Studies have shown that this therapy helps with pain management, and can also be effective for the management of lower back pain.
Another successful therapy for pain management is relaxation therapy. As there is documented proof that stress may cause disease, it’s important to consider how to manage stress in order to reduce pain and muscle tension. Stress-reducing methods include meditation and muscle relaxation. Relaxation therapy has also been documented to help patients experience fewer symptoms of pain.
A sort of meditation which has been termed “moving meditation” is also known as tai chi, and originated in China many years ago. The slow movements and deep breathing of tai chi have both emotional and physical benefits and can help to reduce chronic pain.
How Can Alternatives to Prescription Painkillers Help Prevent Drug Addiction?
One of the biggest problems that faces physicians who are treating patients for acute pain is that many patients who are prescribed prescription painkillers will often continue using the painkiller long after their pain has subsided. If the painkiller has been prescribed, say, for a broken bone or a disease, once that acute pain event is over, people will often keep taking the painkillers to achieve the sense of euphoria they noticed while taking the medication for that pain event.
With chronic pain, the use of opiate pain medication is seen as a long-term solution by physicians to treat the pain of diseases such as arthritis or back pain. The risk of addiction is greater with chronic pain because the pain has an indefinite length, and the physician is not sure when, if ever, the pain will subside or go away.
In order to prevent the likelihood of addiction, physicians need to be more aware of and promote not only alternative therapies, but also non-opioid medications or treatments that will be more beneficial to their patients in the long-term. In addition to the previously mentioned alternative therapies, physicians can encourage their patients to participate in physical therapy and prescribe other medications such as non-steroidal anti-inflammatories and muscle relaxants.
Some anti-depressants have been proven to assist with pain management, as have anti-convulsants. There are also types of epidural injections and other injectable medications that will assist with pain relief.
The Withdrawal Process and Treatment
If you become addicted to an opioid, whether it’s heroin or a prescription opioid, you will feel the physical effects of withdrawal if you attempt to stop using the drugs. The symptoms of withdrawal can be very severe and include difficulty sleeping, pain in the bones and muscles, leg movements that cannot be controlled, upset stomach with either diarrhea or vomiting, and chills or goosebumps. The severity of these symptoms can be so serious that it’s not advisable that someone attempting to withdraw from opioid painkillers do so on their own. It’s imperative that they are monitored by a professional, for both their mental and physical well-being.
The physical dependence on the medication, and the severity of the subsequent withdrawal symptoms, are dependent upon the type of opioid prescribed, the dosage used and the length of time the person has used the medication.
If you or a loved-one is faced with the challenges of opioid dependency, contact 12 Keys Rehab. Our personal care is built on a multidisciplinary approach to recovery, which includes pharmacological treatments, one-on-one and group therapy sessions, and time for personal reflection.