Managing Pain when you have An Addiction
You are dealing with pain from an injury or surgery. The pain is a problem and you need to get it treated. But you also have a history of opioid or narcotic addiction and aren't sure how you'll handle pain medication.
Opioids can be used to relax the brain and reduce pain. They're also highly addictive. They are still an option for pain management, even though doctors have stopped prescribing them as often as they did in the past. The U.S. issued more than 150,000,000 prescriptions in 2019 for opioid medications such as:
- Oxycodone (OxyContin, Percocet)
- Hydrocodone (Vicodin).
A history of opioid misuse can make pain management tricky, and not just because of the danger of addiction, says Trent Emerick, MD, program director of the pain medicine fellowship at the University of Pittsburgh/UPMC Pain Medicine Program.
There is more risk, however, such as the possibility of cravings for medication you have taken. However, opioid abuse can also lead to a greater tolerance and lower tolerance for pain.
He says, "Whether you're using prescription opioids or non-prescription opioids, you must have effective pain management. Or even better than people who have not used opioids." The greatest risk is not treating your pain or trying to manage it yourself.
What are the Alternatives to Opioids
The risk of developing dependence on opioids is significantly increased if you take them for more than three days. Ask your doctor if another drug might be able to relieve your pain as effectively or more efficiently. You might also consider:
These are nonprescription pain medication. Studies show that pain relief with acetaminophen or ibuprofen may be just as effective as those prescribed opioids.
Tildabeth DOscher, MD says that "It's impossible to say enough: If there's a need for pain medication after an operation, for instance, Tylenol, ibuprofen, or both, I can help." She's the fellowship director of addiction medicine at the University of Buffalo.
The physical therapy. An exercise program can be created by a physical therapist to help improve movement, function, and lower pain. You may be able to access other useful tools, such as ultrasound and whirlpools.
Acupuncture. A trained acupuncturist places thin, small needles in different areas of your skin to interrupt certain pain signals.
Shots and nerve blocks. Injections of local anesthetics, or any other medication may be used to shorten the pain.
Psychological assistance. Cognitive behavioral therapy (CBT) can "retrain your brain to perceive pain."
"Pain psychology services is a huge and growing field in the pain management world, specifically for patients who have a history of chronic pain or opiate addiction or misuse after surgery," says Emerick.
If you're able to do a televisit, or an in-person appointment once in a while to speak to a psychologist it may help to reset your mindset so that you're able to say, "OK, this is something I can handle."
Strategies to succeed
Your doctor might decide that opioids may be best for you. This will reduce both your pain level and the risk of becoming dependent.
Be upfront about your history of addiction. Your doctor should have an open conversation about your addiction history. "You want to make it really clear to your providers that this is an issue, and that includes mentioning any family history, since addiction is a heritable illness," Doscher says.
Know your pain management goals. Doscher said that it is crucial to manage pain in a way that doesn't interfere with your everyday life. However, Doscher cautions against expecting to live without pain. She says, "The idea that pain is an American concept is false. It is an important symptom which tells our bodies what can be done and not.
Accept your fears. You will feel pain more intensely if you are afraid. Recognizing that your body will feel discomfort is a good way to help it manage. Doscher says, "When you accept pain and remember that it is normal and okay, it can help you cope."
Your advocate is you. Your doctor should know your level of comfort with medication and give you safe boundaries. Your doctor can say, "I would like the maximum dose of medication and it should not exceed 3 days." Doscher says, "Please don't refill the medication for me. This is an issue I have had before." Emerick states that your doctor will be able guide you on the pain management route that feels best to you.
He says, "I have seen patients with opioid misuse histories and they don't want to be touched again." So we devise a strategy to prevent them from using opioids by multimodal medication. Patients with other conditions are less concerned about the possibility of a relapse. They are willing to take opioids under strict supervision.
Doscher says that even in some critical situations, like a traumatic injury, there are ways to lower your risk for addiction.
According to her, "In life-threatening emergency situations we have the option of intramuscular or IV opioids." The risk of them becoming addicted is virtually zero. "We don't wish to flip that switch again."