In the addiction industry, it’s often difficult to help patients who have become addicted due to injury or illness. Many people who use opiate drugs for the first time do so at the behest of a doctor, to temporarily help them with acute pain from an accident, surgery, or chronic illness. Pain management, after all, was the purpose for developing all of these opiate drugs in first place. For a small percentage of people–which is still much more than acceptable—this initial prescription will lead to a spiral of addiction. For others, they will simply need more (and stronger) opioid drugs to continue to manage their pain.
Many people who use opioids for a week or two end up needing more even once their prescription has ended and the pain has ceased. Others, however, may experience more long-term pain and take the drugs for a longer period of time. Because the drugs are deemed medically necessary, few doctors worry about the possibility of addiction. For these chronic pain patients, it seems, drug tolerance is a symptom of the disease, not a problem with the drug. Almost every type of drug that exists, whether pharmaceutical or illegal, has some element of tolerance involved. The body simply stops responding to the small dosage and it needs to be tapered up. This is where the lines between addiction and necessary pain management are often blurred for most doctors. It’s hard to play psychologist and ascertain if a patient’s pain is “real” or exaggerated due to a dependence on the drug.
New research shows that maybe one of the reasons that opioids in regard to pain management have become so muddled. Lost in the story is the truth about when, and where, a patient first takes an opiate drug. New research shows, for example, patients who are on narcotic pain medication prior to knee surgery do worse with pain levels after the surgery. Could it be that tolerance develops much too quickly when we use meds for the initial injury, instead of healing? In addition, a study presented at the American Pain Society (APS) 2017 Annual Scientific Meeting revealed that post-surgery pills are provided en masse to patients in many cases, with a stunning assertation that doctors seem to prefer to prescribe the pain away, rather than seek out alternate treatments. “We found that one in four patients had at least 200 unused morphine equivalents leftover at 1 month (postsurgery),” first author, Mark E. Bicket, MD, an assistant professor at Johns Hopkins University School of Medicine, in Baltimore, Maryland, told Medscape Medical News. “These leftover opioids represent an important reservoir of pills that can contribute to opioid injuries and deaths.”
Addiction treatment and pain management science have really only begun to intersect in recent years, but it’s apparent that some people who have pain are being over-treated, while others are being under-treated. Some people legitimately start taking more pills than prescribed because of their pain, only to find themselves now addicted to a drug that causes them more pain and no relief from their initial pain struggle.
Experts will point out that opioid drugs need not be the first line of defense, and those doctors who work in legitimate pain management fields (not pill-mills) have many tools to offer those who truly experience ongoing, chronic pain. Pain management isn’t just offering a supply of pills, but often encompasses treatments such as meditation, acupuncture and non-opioid drugs such as low level antidepressents to battle nerve pain.
It will take a true intersection of pain management doctors and addiction treatments to help address pain management needs for those who suffer from chronic conditions. It’s important that each expert is aware that they need each other in order to provide the most effective treatment for their patients who are in pain.