Pain management is one of the most significant healthcare crises in the US, with nearly 50% of Americans visiting physicians with a primary complaint of pain each year. It can be acute and short-lived or chronic when it lasts for months or years. Pain can affect a person's quality of life and make it hard to work.
Pain management aims to safely minimize pain and increase your ability to do everyday activities. Healthcare providers may employ various methods to achieve this, including prescription painkillers, commonly known as opioids. Opioids are among the most potent tools in the arsenal against pain. These drugs have been used for centuries to alleviate suffering, but their use hasn't been without risks and controversy.
Opioids, a class of drugs that includes prescription painkillers like oxycodone, hydrocodone, and morphine, are often a go-to solution for managing moderate to severe pain. Healthcare providers prescribe opioids for various reasons, including:
Opioid medications work by binding to specific receptors in the spinal cord and brain, altering the perception of pain. While they are highly effective in providing relief, opioids come with a substantial risk of addiction.
Opioids are highly addictive because they hijack the brain's natural reward system, creating a robust association between drug use and pleasurable sensations. When introduced to the body, opioids interact with specific receptors and trigger the release of neurotransmitters, particularly dopamine, in the brain's reward pathway.
Dopamine is associated with pleasure, reward, and reinforcement of enjoyable experiences. Therefore, its increased release heightens the sense of pleasure and euphoria and reinforces the association between opioid use and positive feelings.
Opioids not only activate the reward system but also effectively alleviate pain by modulating pain signals in the brain and spinal cord. The dual effect of pain relief and euphoria makes opioids particularly appealing to those experiencing both physical and emotional distress. However, the repeated association between opioid use and pleasure creates a habit, and the brain begins to crave the drug.
Responsible opioid use can turn into drug dependency due to various factors, including:
Opioids are often prescribed for short-term pain management. However, in some cases, when pain persists, patients may continue to use opioids for an extended period. Prolonged use increases exposure to opioids, which can cause changes in the brain's chemistry and heighten the risk of dependence.
Tolerance is a physiological adaptation where the body becomes accustomed to the presence of opioids, requiring higher doses to achieve the same level of pain relief. As a result, one may gradually escalate their opioid use. Increased tolerance can occur even with responsible use, mainly when opioids are used over an extended period. This can contribute to a cycle of higher doses, which in turn heightens the risk of developing dependency.
Regular follow-ups and assessments are crucial to evaluate the effectiveness of the treatment, assess pain levels, and identify any signs of misuse or dependence. If healthcare providers do not closely monitor a patient's response to opioids and make necessary adjustments to the treatment plan, there's a risk of the patient inadvertently developing dependence.
Chronic pain often coexists with psychological factors such as stress, anxiety, or depression. Opioids not only provide pain relief but also may temporarily alleviate emotional distress. Individuals may unintentionally start using opioids for emotional relief, contributing to the development of psychological dependence. Using prescription opioids to self-medicate is a form of substance abuse and can result in addiction or overdose.
Lack of patient education about the risks of opioid use and the importance of adhering to prescribed doses can contribute to dependency. Patients must understand the potential consequences of prolonged use and the importance of following the prescribed treatment plan.
The initial prescribing practices play a critical role. Overprescribing, prescribing high doses, or prescribing opioids without a precise treatment plan can contribute to the development of dependency. Responsible prescribing involves a careful assessment of the patient's needs, consideration of non-opioid alternatives, and ongoing monitoring.
Here are some real stories and case studies from real people who shared their accounts about dealing with prescription opioids. The CDC initially published these stories.
Ann Marie's story is a tragic illustration of the devastating progression of prescription opioid addiction. Her son Christopher, a talented 20-year-old baseball player, was prescribed opioids for back pain after being involved in a minor accident. But his tolerance escalated quickly, leading him to seek out multiple doctors willing to prescribe more of these powerful medications.
Over a short period, Christopher's opioid intake soared from one pill a day to a staggering 25 pills a day. This rapid escalation is a clear sign of the development of dependence and addiction. The opioids took a toll on his physical health and also had a profound impact on his overall well-being. Everything he had once valued, including family, academics, and his passion for baseball, began to lose importance.
Christopher's behavior underwent a drastic transformation. He struggled with sleep, frequently stayed out at night, and became defensive and combative towards his loved ones. Recognizing the severity of her son's addiction, Ann Marie attempted to get him into various treatment facilities.
Unfortunately, Christopher faced rejection or expulsion due to his poor behavior. Sadly, Christopher's addiction progressed, and two years later, he fatally overdosed. Ann Marie started Christopher's Reason to help direct those struggling with opioid addiction to the treatment they need.
19-year-old Britton got prescription opioids for a severe shoulder injury that he sustained while serving in the US Army. But by age 22, he was addicted. His addiction was compounded by his relationships with fellow Veterans who misused prescription opioids and his wife's substance use disorder.
In the 11 years that he struggled with opioid use disorder, Britton separated from his wife, who later died due to drug use complications, and lost custody of his children. He was even arrested and jailed in 2018.
Britton attributes his recovery to the structured therapy program. He is now remarried and raising his children. He hopes that his story will help demonstrate that opioid use disorder can happen to anyone and that there's help for those facing the disease.
Many non-opioid approaches are available to help manage pain. These therapies and treatment options can help alleviate pain and minimize the need to depend solely on opioids for pain relief:
Prescription opioids are an essential part of pain management, especially in situations where pain is severe or difficult to control through other means. When used responsibly and under the vigilant support and supervision of healthcare professionals, opioids can provide effective relief for many different types of pain. The collaboration between patients and healthcare providers is fundamental for the success of pain management.