Managing Pain When You Have an Addiction

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You have an injury, need surgery, or deal with chronic pain that interferes with your daily life. You need treatment for your pain. But you also have a history of opioid or narcotic addiction and aren’t sure how you’ll handle pain medication.

Opioids are drugs that relax your brain and relieve pain. They’re also highly addictive. Although doctors prescribe them less often than they used to, they’re still a common choice for pain management. In 2019, more than 150 million prescriptions were written in the U.S. for opioid drugs such as:

A history of opioid misuse can make pain management tricky, and not just because of the danger of addiction, says Trent Emerick, MD, program director of the pain medicine fellowship at the University of Pittsburgh/UPMC Pain Medicine Program.

“Yes, there’s more inherent danger, such as taking a medication that may trigger cravings that you’ve fought so much to avoid through recovery,” he says. But past opioid abuse also means you have both a higher tolerance for the drugs and a lower tolerance for pain.

“Whether it’s with prescription opioids or not, you need to have good pain management — or even better pain management than other people who have never been on opioids before,” he says. “Not treating pain and trying to deal with it on your own is probably the highest risk of them all.”

Are There Alternatives to Opioids?

Science shows that taking opioids for more than 3 days greatly increases your risk of dependence. Talk to your doctor to find out whether another type of drug could work just as well — or better — for your pain. Some alternatives include:

Nonprescription pain meds. Research shows that a combination of ibuprofen and acetaminophen is as effective at controlling pain as opioids.

“I can’t say it enough: If you need a pharmaceutical treatment for pain after a procedure, for example, it’s very likely that Tylenol and ibuprofen will take care of it,” says Tildabeth Doscher, MD. She’s the fellowship director of addiction medicine at the University of Buffalo.

Physical therapy. A physical therapist can work with you to create an exercise program to improve your movement and function and decrease your pain. They may also give you access to other helpful tools such as whirlpools, ultrasound, and deep-muscle massage.

Acupuncture. In this practice, a trained acupuncturist inserts small, thin needles into different places in your skin to disrupt certain pain signals.

Shots or nerve blocks. For muscle spasms or nerve pain, injections with local anesthetics or other medications may help short-circuit your pain.

Psychological help. Cognitive behavioral therapy can help “retrain” your brain’s pain perception.

“Pain psychology services is a huge and growing field in the pain management world, specifically for patients who have a history of chronic pain or opiate addiction or misuse after surgery,” says Emerick.

“If you can do a tele-visit or an in-person visit once or twice to talk to a psychologist, oftentimes it can help … reset your frame of mind so you can tell yourself, ‘OK, I can get through this.’ ”

Strategies for Success

In some cases, you and your doctor may decide opioids are the best way to manage your pain. To lessen both your pain and your risk of dependence:

  • Be upfront about your history of addiction. Have an honest conversation with your doctor the first chance you get. “You want to make it really clear to your providers that this is an issue, and that includes mentioning any family history, since addiction is a heritable illness,” Doscher says.
  • Understand your pain management goals. While it’s important to address pain that’s interfering with your daily life, don’t expect to have zero pain, Doscher says. “This idea that we have to be pain-free is a very uniquely American thing, but it’s false,” she says. “It’s an important symptom that tells our body what we can and can’t do.”
  • Face your fears. If you’re afraid of pain, you’ll probably feel it more intensely. When you acknowledge that you’re going to feel some discomfort, you can help your body manage it better. “When you expect pain and remind yourself that it’s normal and OK, it can actually help you cope,” says Doscher.
  • Be your own advocate. Be sure your doctor knows your comfort level with the medication, and set boundaries that seem safe to you. “You can tell your doctor, ‘I want the minimum dose and no more than 3 days of it. Also, please don’t refill it for me because this is a problem I’ve had in the past,’” says Doscher.

Your doctor should be able to guide you along whichever pain management path feels right to you, Emerick says.

“I see patients who come in with opioid misuse history and never want to touch them again, so we find a plan to avoid opioids using multimodal medications,” he says. “Other patients aren’t as worried about a relapse and are more than willing to try opioids as long as they have close supervision.”

Doscher says that even in some critical situations, like a traumatic injury, there are ways to lower your risk for addiction.

“With life-threatening emergencies, we can turn to IV or intramuscular opioids instead of oral options,” she says. “That way, the risk of over-taking them is zero. We just don’t want to turn that switch on again.”

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