Chronic pain is a debilitating condition, and it often leads people to abuse prescription pain medications.

The presence of chronic pain can complicate addiction treatment. Some drug rehabs offer support and alternative treatments for chronic pain.

Categories of Pain

Pain is an experience everyone can identify with. Physical pain is a warning that there is potential damage to an area of the body.

The most basic division of the levels of pain includes two categories as described by the American Academy of Pain Medicine (AAPM):

  • Chronic pain is consistent pain that persists for 12 weeks or longer.
  • Acute pain is considered to be pain that does not persist for at least 12 weeks.
  • Headache pain
  • Joint pain 
  • Back pain
  • Neuropathic pain (pain resulting from nerve damage)

Chronic Pain Can Be Divided Even Further

Chronic pain is considered to be a long-term medical disorder. AAPM estimates that more than 100 million people in the United States have chronic pain. The prevalence rates for chronic pain increase as people age.

The most common approach to addressing chronic pain is to use medication. Many of the medications used to address chronic pain, like opioids, are potentially addictive. Long-term use of these medications can produce physical dependence, even in people who only use them to control pain.

Physical Dependence Not Necessarily a Sign of Addiction

Someone who is being treated for chronic pain with powerful medications, such as opioids, and only uses the drugs as prescribed by their physician may develop physical dependence on them. This is not an instance of addiction or a substance use disorder.

By definition, an addiction requires that the person is not solely using drugs for medicinal reasons, and their use of drugs has resulted in issues with functioning and/or significant distress in their life. 

When physical dependence occurs as a result of the nonmedical use of drugs, and there is significant distress and/or impairment in functioning, then physical dependence can be considered a sign or symptom of a substance use disorder.

Chronic Pain and Substance Use Disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) has estimated that misuse and abuse of prescription medications happen with about 20 to 30 percent of individuals who take them. The percentage of individuals who develop substance use disorders as a result of taking prescription medications is lower, estimated to be between 8 and 12 percent. 

The epidemiological research approximating the rates of misuse and abuse of medications in chronic pain patients are consistent with the findings from SAMHSA, indicating that while addiction in individuals with chronic pain is certainly an issue, it is not as widespread as often believed.

Nonetheless, individuals who continue to use powerful prescription medications over the long term are at an increased risk to begin to abuse them.

When a person with chronic pain is also diagnosed with a psychological disorder such as depression, the potential for the development of a substance abuse issue is increased even further.

Substances of Abuse for Individuals With Chronic Pain

People who live with chronic pain are at significant risk of abusing opioid drugs.

In addition, AAPM and the American Psychiatric Association (APA) report that this group may commonly abuse:

  • Alcohol
  • Benzodiazepines
  • Cannabis products
  • Hypnotics and sedatives (sleep-enhancing drugs)
  • Muscle relaxants
  • Tobacco products

Drug Rehab and Chronic Pain Treatment

Individuals treated for a substance use disorder in an inpatient hospital unit will have around-the-clock access to medical care, and this includes assistance addressing issues with chronic pain.

Those in residential treatment programs where there is not 24-hour medical care on site are often thoroughly assessed before being admitted to the program. Issues with chronic pain would be identified during the assessment. If the residential program is unable to meet the person’s needs, it should refer the client to a program that can.

Many different rehab centers specialize in treating serious medical issues like chronic pain. It’s important that the chosen rehab center can effectively address this medical issue as well as the addiction.

Effectiveness of Medications

According to AAPM, about 58 percent of people who use prescription pain medications report significant relief in their level of chronic pain, and about 41 percent of people who use over-the-counter medications for chronic pain relief find them to be effective.

Because the medical profession has adopted the position that the control of pain is a top priority in the treatment of all individuals, rates of prescription medications to treat pain have significantly increased in the United States. AAPM reports that about 30 percent of all prescription opioid drugs in the world are prescribed in the United States.

Prescription medications are not always fully effective for pain relief. Alternative methods of pain control are often combined with prescription and over-the-counter medications to assist in the treatment of chronic pain.

Chronic Pain Treatment in Drug Rehab

Individuals who also have co-occurring issues with chronic pain will be evaluated upon entering a drug rehab program, and their treatment plans will address all areas of dysfunction and discomfort.

For individuals who are undergoing medical detox from opioids or benzodiazepines, the use of opioid replacement medications (methadone or Suboxone) may also assist with pain control, as will the use of benzodiazepines for alcohol or benzodiazepine withdrawal.

However, individuals who have histories of substance use disorders are often not expected to be able to maintain a medicinal regimen of opioids or benzodiazepines once they leave the program because these drugs can be significant drugs of abuse.

Alternative methods of pain control would be implemented in the drug rehab program to allow the individual to find a solution that suits their needs.

Some Alternative Methods To Chronic Pain Control

There are quite a few alternatives to the use of addictive medications to treat chronic pain in recovery.

  • Non-opioid medications to control pain, such as antidepressants and anticonvulsants, can be used in some cases
  • Physical therapy can often be effective. 
  • Behavioral modification and psychological techniques can be used to reduce the experience of pain. These might include stress management techniques and diaphragmatic breathing.
  • Complementary treatment for pain, such as massage, hypnotherapy, herbal medications, dietary alterations, and even exercise programs, can be added to the routine for individuals who can tolerate them.
  • Therapy can help individuals learn to control their pain and change negative thinking patterns that can exacerbate emotional states that can increase the personal experience of pain.
  • Distraction techniques, including mild exercise, socializing with others, and even playing video games, can be useful in some cases.

Using Opioids

The continued use of opioid replacement medications after a medical detox program may be a possible alternative for some people (the use of buprenorphine or methadone).

Some individuals may use opioid medications with a signed pain control contract. This contract allows them to use opioids under certain agreed-upon conditions. The person may be subject to random drug testing, have their treatment providers monitor all their prescriptions, use alternative methods of pain control in conjunction with opioids, and have limits on the amount of medication they can take each day.

Programs Need To Be Flexible

No one particular solution can be used across the board for people who have chronic pain and substance abuse issues. A combination of approaches that include medication, behavioral modification, therapy, distraction techniques, and other methods often works best.

Over time, individuals will need adjustments to their personalized program because certain interventions may decrease in effectiveness. Also, newer methods may surface that can benefit the person. 

Because individuals who struggle with pain often become emotionally distraught when things do not go their way, they remain at risk to use drugs or alcohol to self-medicate their issues. Just getting through rehab will not be sufficient for these individuals. They require long-term aftercare to maintain sobriety and experience quality in their level of functioning.

Chronic pain can complicate the recovery process. It’s imperative to work with a program that can help to control chronic pain. Otherwise, relapse is highly likely.

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