Chronic Pain and Substance Abuse

Experts estimate that about 20% of the population struggles with chronic pain.

Suffering from chronic pain can increase a person’s risk of developing a substance abuse problem, which means addiction treatment programs must address pain management as part of the foundation for a sober lifestyle.

Understanding Chronic Pain

Chronic pain comes in many forms. The International Classification of Diseases (ICD-11) suggests that there are seven categories of chronic pain.

Chronic primary pain: Experiencing three months of persistent pain in one or more body regions that can’t be explained by another condition
Chronic cancer pain: Cancer or treatment related pain
Chronic posttraumatic pain: Pain lasting three months or longer after trauma or surgery, excluding infectious diseases or preexisting conditions
Chronic neuropathic pain: Pain attributed to damage of the somatosensory nervous system
Chronic headache and orofacial pain: Pain beginning in the head or face and occurring for at least half of the days over a three-month period
Chronic visceral pain: Pain originating in an internal organ
Chronic musculoskeletal pain: Pain in the bones, muscles, joints, or connective tissue

Regardless of the type of pain, chronic pain creates a number of problems.

Causes sleep disturbances, leading to an overall lack of energy
Makes it difficult to work, leading to financial problems
Makes it harder to enjoy socializing, straining relationships with family and friends
Increases stress, anxiety, and depression
Impairs judgement, reasoning, and cognition

Chronic Pain as a Risk Factor for Substance Abuse

Chronic pain is a significant risk factor for substance abuse. Prescription opioid medications have a high risk of abuse when they are not taken as directed, and chronic pain sufferers often up their dosage in an attempt to seek relief. They may also mix medications with alcohol or illegal drugs in an attempt to get their pain levels under control.

Some of the signs that a chronic pain sufferer may be experiencing a substance use disorder include:

Seeking higher doses of medication
Mixing pain medications with alcohol or illegal drugs
Asking for prescriptions from multiple doctors
Becoming defensive when confronted about substance use
Withdrawing from family and friends
Drastic changes in mood and behavior
Decline in personal hygiene and appearance

Addiction Treatment for Chronic Pain Sufferers

If someone who suffers from chronic pain is in need of addiction treatment, it’s vital that the care team works to find a way to keep pain levels under control. Failing to address a factor that likely played a key role in the development of a substance use disorder greatly increases the risk of relapse.

Approaches to treating chronic pain need to be personalized to fit each person’s unique symptoms, but there many drug free approaches that have been effective in lowering pain levels.

Movement based therapy: The use of physical therapy, yoga, Pilates, and/or tai chi can alleviate many types of musculoskeletal pain. Exercise also helps to release endorphins, which block pain signals in the body.
Physical manipulation: Massage and/or chiropractic care can release tension, improve circulation, and promote greater mobility.
Mind/body medicine: Meditation, guided imagery, biofeedback, and relaxation exercises can help manage pain by controlling emotional responses such as stress, panic, and fear.
Energy healing: Although research is ongoing, some studies have shown benefits to using alternative practices such as acupuncture, acupressure, reiki, and qigong as part of a pain management plan.
Diet and nutrition: Eating an anti-inflammatory Mediterranean diet rich in whole grains, fish, fresh fruits, leafy vegetables, and olive oil can reduce pain and improve overall physical health.
Sleep hygiene: Setting a strict sleep schedule, creating a comfortable sleeping environment, and avoiding screen time or overly stimulating activities in the evening can help patients with chronic pain get the rest they need.
Environmental changes: Structuring one’s surroundings to reduce stress can help ease chronic pain. This might include adding soothing elements to an office workstation, rearranging the home to reduce the amount of effort needed to clean and perform chores, or creating a quiet space reserved for rest and relaxation.
Social changes: Building a strong support system of family and friends won’t relieve the physical symptoms of pain but can provide patients with the emotional resources necessary to manage their condition.

If the use of medications is determined to be necessary as part of a pain management strategy, an opioid agreement may be useful. This is a structured contract between the person in recovery and his or her physician. The opioid agreement addresses steps that will be taken to promote safe use of the medication, such as having a family member dispense the drugs as needed, only using one pharmacy for prescriptions, and agreeing to periodic drug tests.