The Link Between Chronic Pain and Opioid Addiction

People who live with chronic pain often face a difficult choice. Opioids are often used to treat chronic pain, but they come with a high risk of opioid addiction, which can cause a host of health problems and even increase pain in the long run. Patients have to weigh the risks and rewards of opioid treatment and decide whether to seek alternative pain treatment to avoid the risks of addiction.

The Paradox of Chronic Pain and Opioid Addiction

Chronic pain and addiction share certain neurological pathways, creating a deep link between the two. Over time, opioid use can lead to physical dependence and opioid tolerance, meaning needing more opioids to achieve the same pain relief. Additionally, over time, patients can develop increased pain sensitivity, which also increases the need for higher opioid doses.

Opioids and chronic pain can also lead to neuroinflammation in the brain, leading to depression and anxiety. These mental health conditions increase the psychological risk of addiction.

Risk Factors for Opioid Addiction

Not everyone who uses opioids for chronic pain will develop an addiction. Certain risk factors increase the risk of addiction, although the risk is still high for everyone.

These factors include:

• Personal or family history of substance use disorder
• Mental health conditions (i.e. depression, anxiety, PTSD)
• Younger age at first opioid use
• High opioid dosage
• Use of fast-acting or short-release opioids
• Poorly managed or severe chronic pain
• Social isolation or high stress levels
• Limited access to alternative pain treatments
• Using opioids with other CNS depressants (e.g., benzodiazepines)

Do You Have an Opioid Addiction?

If you take opioids for chronic pain and think you may have an addiction, understanding the definition of opioid addiction can help you to know if you need to seek help. The formal definition according to the Statistical Manual of Mental Disorders has 11 criteria that determine whether an opioid addiction, also known as a substance use disorder, is present.

1. Using opioids more than intended or for longer than intended
2. Wanting to reduce or stop opioid use but not being able to
3. Spending excessive amounts of time using opioids or recovering from using opioids
4. Feeling cravings for opioids
5. Failing to live up to responsibilities due to opioid use
6. Having relationship problems because of opioid use
7. Giving up activities that you enjoy in order to use opioids instead
8. Engaging in risky behaviors like driving while under the influence of opioids
9. Continuing to use opioids in spite of negative consequences like health issues
10. Needing more opioids to get the same effects
11. Having withdrawal symptoms when you are not using opioids

Having two to three of these symptoms indicates a mild substance use disorder, four to five is considered moderate, while six or more is severe.

Alternatives to Treating Chronic Pain

If you have an opioid addiction, you’ll need to seek addiction treatment, but you’ll also need to find alternative treatments for your pain. Several options are available, including:

• Non-opioid pain medication: Over the counter medications like ibuprofen or acetaminophen may offer some relief. Other options depend on the source of the pain, but may include:
  • Muscle relaxers for muscle spasms
  • Nerve block injections
  • Steroid injections to reduce inflammation
  • Topical creams and patches can help to numb specific areas
  • Antidepressants for nerve pain
  • Anti-seizure medications for nerve pain
• Physical therapy: Physical therapy can be very effective for some kinds of pain, strengthening certain muscles, and increasing flexibility and joint mobility. While physical therapy lasts temporarily, you can continue to do the exercises you learned on your own.
• Exercise: Being sedentary can lead to pain, so exercising regularly can provide some relief. Yoga, in particular, is helpful for many types of pain.
• Chiropractic treatment: This kind of treatment can help with muscle tension and restore nerve function. It can also increase mobility and reduce inflammation.
• Surgery: As a last resort, some kinds of pain can be surgically treated.

Treating Opioid Addiction

Treatment for opioid addiction generally comes in three forms.

Inpatient Treatment

Inpatient treatment for opioid addiction lasts from 30 to 90 days. An inpatient treatment program includes a period of detox, during which you are kept safe and comfortable as you go through withdrawal, and intensive therapy, both individually and in groups. You may also be treated for any co-occurring disorders that you may have, such as anxiety and depression. Medication may be part of the treatment.

Group therapy is critical to the treatment process, giving you the opportunity to share emotions, experiences, and challenges with peers. You’ll likely form mutually supportive relationships with some of these peers which may last beyond treatment.

The type of therapy most commonly used in opioid addiction treatment is cognitive behavioral therapy (CBT). CBT teaches you to recognize your own irrational thoughts and negative emotions and to challenge them using more reality based, positive thinking. It also teaches you health coping skills to face life’s challenges without opioids.

Partial Hospitalization Programs (PHPs)

A partial hospitalization program (PHP) allows you to live at home while attending treatment for four to six hours per day, usually five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually.

More often than not, a PHP program is a transitional step that occurs after inpatient treatment, although it can be an alternative to inpatient treatment.

Intensive Outpatient Programs (IOPs)

An intensive outpatient program (IOP) consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held in the evenings so that you can still go to work or attend school. Treatment, again, involves individual and group cognitive behavioral therapy.

IOPs can be standalone treatments, or they can be attended after inpatient treatment, PHPs, or both.

Comprehensive Treatment

The most effective treatment for opioid addiction, particularly if it is severe, is a comprehensive treatment program that consists of an inpatient program, a PHP, and an IOP. Research shows that success rates increase the longer the treatment program. Even after IOP, support should continue through support groups, individual therapy, or both. Recovery from opioid addiction, or any addiction, is a lifelong process that requires dedication and a strong support network.

In Closing

Treating chronic pain with opioids is tricky because opioids are so addictive and because of the paradoxical link between pain and opioids. If you are ready to seek treatment for your opioid addiction, Bridges of Hope is here to help. We are committed to providing comprehensive, compassionate, and individualized care so that you can live a healthier life. Reach out today to learn more.