Painkillers - and the risk of addiction?

I thought this was a great article about painkillers and the worry a lot of people have about taking them and potentially becoming addicted.  I know I absolutely have that fear and take the painkiller I use (Lortab) only when I absolutely can't take the migraine pain anymore.  It's only a "mask" over the pain but does help me finally relax so the other meds can kick in. 

The article below is another great one from the Bottom Line Secrets newsletter.  You can subscribe to this by clicking here:

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Loss of Innocence

We've all read the headlines about celebrities checking into rehabilitation facilities because of substance abuse. While some of their problems may be due to lifestyle and personal choices, many are rooted in unrelated injuries that were treated with prescription painkillers. While celebrities make headlines, innocent families across the country are being torn apart every day by these highly effective -- but very powerful -- medications.

The question is, are they too effective? The stories about "instant addiction" concerning OxyContin and similar powerful painkillers have frightened many people and made them wonder if living with severe pain wouldn't be better than risking drug addiction. Are there better and safer alternatives for pain treatment?

Opiates' Power

For insight into this important problem, I called Sudhir Diwan, MD, director of the division of pain management in the department of anesthesiology at New York-Presbyterian Hospital Weill Cornell Medical Center in New York City. Dr. Diwan explains that these painkillers are opiates, a powerful class of drugs that includes heroin and methadone, as well as morphine, Percocet, Demerol and Vicodin, among others. When taking any of these opiate painkillers, he says, there are three by-products to consider...

• Addiction. This is not a physical response but rather a psychological reaction that is very similar to any other addiction including shopping and gambling.
• Dependence. This response is physical and relates completely to the medication. Should a person stop using the drug abruptly, physical side effects will occur.
• Tolerance. In time, users require greater amounts of the drug to address an unchanged amount of pain.

Dr. Diwan says that psychological addiction is rare among people using opiate painkillers to treat authentic pain. That said, before a doctor prescribes an opiate, he/she has a responsibility to ensure that the patient is a good candidate -- that is, he/she does not have a history of substance abuse... a personality disorder, such as borderline personality disorder, in which people are very prone to addiction... or other condition that could predispose him to addiction. (When in pain, people with personality disorders will still be treated, but with a regimen appropriate to their situations.)

Physical dependency can happen to anyone who takes an opiate for more than a few weeks. This makes it critical for people who are ready to stop treatment to wean from it over time and with careful supervision. Tolerance, which also builds over three to four weeks, requires some adjustment in treatment -- either a change in the amount prescribed or in the type and balance of painkillers being used including, perhaps, adding the nonopiate COX-1 drugs -- naproxen (Aleve), aspirin, etc.

PseudoAddiction

A complicating side issue is a situation doctors refer to as "pseudoaddiction." This describes people who either have a source of pain that has been misdiagnosed and so the pain medications are not effective in treating the pain or who become so anxious about the possible recurrence of pain that they take more and more of the drug prophylactically. To the outside world, this appears to be addiction, but Dr. Diwan says that it is not -- doctors need to understand what is behind the behavior and address it to avoid a seemingly addictive behavior pattern.

Long-Term Needs

For patients who require long-term pain control, the goal is to block the pain so that the patient doesn't have to experience it at all. According to Dr. Diwan, this means that doctors must be especially sensitive to signs of abuse for long-term problems -- patients who regularly "lose" the prescription or pills or have multiple prescribing doctors.

Patients must talk to their doctors about other methods of pain control, such as longer-acting sustained-release drugs. Long-acting drugs also have fewer psychological effects, Dr. Diwan says, because there are no highs involved as there are with short-acting medications. For example, there are two types of OxyContin -- one is short-acting and gives the user a rush... the other releases more slowly and so doesn't provide a rush.

Don't Try This Alone

Opiates are not to be taken lightly. Dr. Diwan emphasizes that anyone who requires opiates should do so under the close supervision of a doctor who is highly trained in managing them. In addition to your regular doctor, work with a pain management specialist, who will be far more familiar with risks and benefits of different treatment protocols. Also, include members of your family in conversations with your doctor(s). Opiates can distort an individual's judgment and behavior, so those who are close can provide feedback on what they are witnessing. Opiates should not be taken with alcohol or any medication that can cause sedation.

NonPharmaceutical Options

Dr. Diwan advises chronic pain sufferers to examine alternative methods to relieve their pain, such as acupuncture, chiropractic or deep tissue massage. See last week's Daily Health News for the huge impact chiropractic has had on vack pain... and for its impact on reducing costs associated with controlling back pain. (Daily Health News May 12, 2005.)

Mark Stengler, ND, author of The Natural Physician's Healing Therapies (Bottom Line Books) and Prescription for Natural Cures (Wiley) suggests that when you are ready to come off painkillers, the first step is careful and supervised weaning with your doctor, a process that can take several months.

To make that process easier, he advises acupuncture, chiropractic and deep tissue massage, as well as MSM (methylsulfonylmethane), which has a natural pain relief and anti-inflammatory effect, or proteolytic enzymes. Dr. Stengler likes Repair, by Enzymedica (www.enzymedica.com), also available at health-food stores, which are good for fighting inflammation.

For osteoarthritis pain, he suggests glucosamine sulphate (1,500 mg to 2,000 mg daily) or the herb boswellia (same dosage, and you can take it along with the glucosamine).

That said, should you develop either an acute or chronic pain condition, talk to as many medical professionals as you can about treatment options, leaving opiates as a last resort. If you do need to take them, it is crucial to work with experts in the field to monitor how you use the drugs to be sure you do not fall into addiction.

Comments

[Robert]

Tricky stuff, opiates. Great for acute pain, but for chronic pain, well, tricky. During my stay at Spaulding Hospital in the chronic pain program one of the first things done to patients is take them off narcotics. By the time patients get there, they are usually on pretty high doses and they don't really work that well anymore anyway. (Lucky for me, I'd already stopped using them).

But you know, if it's just a few times a month, you can use them for years without any problem.