Chronic Pain

Persistent pain that lasts 12 weeks or longer may result after a procedure or injury. Unfortunately, pain and treatment of pain may result in addiction. Severe pain causes sensitivity to stress, lessened mobility, appetite changes, mood swings, and other impairments. Severe, persistent pain may appear anywhere in the patient’s body.

Unfortunately, injury to one part of the body may cause pain or other issues in another part. For instance, a patient with post-trauma pain from a car accident may also have nerve pain, headaches, arthritis, back pain, joint pain, anxiety, depression, or experience respiratory problems.

Pain & Addiction Origins

The start of severe pain and addiction is often complex. Severe pain may require the patient to take several medicines. Side effects from pain medicines can disrupt the patient’s daily life and activities. Nerve pain, or fibromyalgia, may cause the patient to feel tired and sore. In this scenario, the patient also experiences emotional frustration.

Pain may originate from conditions like cancer, uterine fibroids, obesity, chronic fatigue syndrome (CFS), inflammatory bowel disease, HIV/AIDS, multiple sclerosis (MS), interstitial cystitis, and more. Patients with severe, long-lasting pain may have correctible lifestyle factors, including poor posture, work-related heavy lifting, wearing poorly fitting shoes or high heels, etc.

Pain management can result in addiction to medicines like opioids.

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Pain & Opioid Addiction

Chronic pain is a major issue in identifying and treating patients with opioid use disorders (OUDs). Patients with inadequately controlled pain may seek drugs to manage their conditions in a similar way to the OUD patient’s need to control their severe pain.

Medical researchers don’t know how often OUD patients experience chronic pain. A review of the literature shows that at least 10 percent of patients weaning from opioids experience chronic pain. In some instances, researchers believe that the OUD patient’s attempts to lower or cut back opioid use on their own result in severe physical pain and suffering. Alternatively, the patient may spend significant time and effort trying to get opioids after their physician refuses to prescribe them.

The OUD patient may experience significant chronic pain. To successfully recover from opioid addiction, the patient requires pain relief strategies that work.

Diagnosing Severe Pain & Drug Addiction

The Diagnostic and Statistical Manual of Mental Disorders, 5th ed.(DSM-5) reports 11 symptoms of opioid addiction. These symptoms could also apply to the patient experiencing severe chronic pain. However, DSM-5 also states that important changes to the criteria for OUDs include the opioid-addicted patient’s need for licensed medical supervision.

Because the DSM-5 cites limitations to distinguishing an OUD diagnosis (patient suffering chronic pain using opioids) to that of a diagnosis of severe pain, consider the following:

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  • Patient “lacks control.” An OUD patient may claim to lose a prescription, increase their dose without doctor approval, “run out of medicine” too soon or go to the emergency room to receive more opioids. The OUD patient can’t take the medication as prescribed.
  • Patient “shows compulsion.” The OUD patient is preoccupied with the tasks of acquiring more opioids—not in getting relief from pain at the present. They resist their doctor’s suggestions to try other treatments for severe chronic pain.
  • Patient “continues to use.” Although the patient may understand that taking opioids to manage pain puts them at risk of harm, they want more. 
  • Patient “craves opioids.” The patient’s first thoughts are taking opioids.
  • Diagnosing OUD is sometimes challenging for medical professionals. Addiction professionals know that patients exhibiting these behaviors are in harm’s way.

Physical Dependence, Opioid Withdrawal & Addiction

Physical dependence and opioid withdrawal are concerning and confusing to many patients. Medical studies show that patients who chronically abuse opioids become physically dependent on them. If the patient stops taking opioids, they experience painful and alarming withdrawal symptoms. 

Patients who exhibit chronic pain and OUD may receive medically-assisted therapies (MAT) to manage these symptoms.

https://www.nccih.nih.gov/health/chronic-pain-in-depth
https://irp.nih.gov/catalyst/v26i5/opioid-addiction-and-chronic-pain Salsitz E. A. (2016). Chronic Pain, Chronic Opioid Addiction: a Complex Nexus. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(1), 54–57. https://doi.org/10.1007/s13181-015-0521-9

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