Factory Girl: Pain Treatment without Addiction

The Question: Are doctors unknowingly feeding into their patients' addictions? The Answer: Has never been simple.

A patient is prescribed painkillers for a chronic condition or injury and ends up dependent on highly addictive opiate drugs. Chronic and debilitating pain, which strikes millions of Americans, can be managed safely without the long-term use of addictive painkillers. New alternatives to opiate drugs — including injections, implants, and non-medical physical therapies can all offer relief without posing a dependency risk.  Patients that suffer with chronic pain, have debilitating lives causing them develop depression, isolation, loss of job, loss of income, and feelings of worthlessness and helplessness, and how it can affect relationships. Unfortunately, many chronic pain sufferers turn to opiate drugs, such as OxyContin, and become addicted. At some point, the drugs are taken for more than just pain relief. (C)

Addiction to opioids is a chronic medical conditions. It occurs in people who are susceptible to brain changes. Once an individual has developed a narcotic addiction the road to recovery is a long and painful one. With the aid of drugs such as buprenorphine (aka: naloxone) and naltrexone, traditional therapies such as methadone, as well as 12 step programs can lead to successful recovery. (B)

It is difficult to discuss the nations' over reliance on opioids meanwhile treating debilitating pain. A study conducted by Community Care was to address this problem on a patient by patient basis. Out of the 1,200 patients 70 percent receive opioids as part of their 'pain management program' including non-narcotic drugs, physical therapy, injections, and appointments with a psychologist. (A)

From the New York Times article, 'Treating Pain Without Feeding Addiction at 'Ground Zero' for Opioids' had me coming back to the question of the source of many addictions throughout the US.  The physicians were interested in talking about any illness that their patients often times miners, waitresses, as well as other professions that were physically painful to the body. The patients, however,  only verbalized their pain and plead for opioids such as Vicodin and Percocet. These pharmaceutical drugs help with chronic pain but for the most recent year as have given birth to an epidemic of addiction and many overdoses. (A)

Many of the physicians from the organization felt inclined to prescribe these drugs because such towns are small where they grew up with their patients. It was difficult for them to deny their patients of treatment. The community Care decided to hire an anesthesiologist to treat chronic pain, relieving the primary care physicians and nurses of this duty and allowing them to concentrate on patients that they were comfortable conditions to treat. (A)

 

Once the addition to narcotics has fully formed and changed the persons brain, a physical dependence also forms along with it. Prescription drugs begin to alter the very circuits responsible for a person's mood and reward behaviors. When taken for long periods, almost every system of the body is affected as well. So whenever the drugs are cut off, the individual begins to experience 'opioid withdrawal symptoms' that include craving for drugs, diarrhea, large pupils, yawning, abdominal pain, chills/goose bumps, nausea/vomiting, body aches, agitation and severe negative mood swings. (B)

Opioid withdrawal is so difficult to endure that many times medications are given to prevent the symptoms during withdrawal symptoms during detox so that people can ease out of their physical dependence on opioids. Withdrawal of opioids are so difficult that it is often times the main reason people relapse and continue prescription drug abuse. The syndrome of opioid withdrawal itself is intensely unpleasant and makes people with well established narcotic addictions will do anything to avoid this feeling. Withdrawal lasts from hours to several days to weeks, depending on how long and how much a person has used their drug of choice. After the intense initial symptoms subside, some physical and mental discomfort may persist for weeks. (B)

Methadone, a long acting opioid drug, is a well known medication used for opioid withdrawal symptoms. This drug activates the opioid receptors that are stimulated by the very narcotics being used. This effectively removes any withdrawal symptoms during detox. Using the proper dose of methadone, the drug cravings are eased without causing a euphoric feeling. The dose is then slowly tapered off, allowing the person to become physically independent of the drug without the symptoms of withdrawal. This drug is the most effective known treatment for narcotic addictions. (B)

Other medications such as Buprenorphine and Naloxone (suboxone) are also used for detox from prescripion drug addiction. Buprenorphine functions in activating opioid receptors, reducing drug cravings, and preventing withdrawal. Naloxone, helps prevent missuse of the medication. Clonidine is a blood pressure medicine that acts on the brain.  Clonidine reduces the effects of the "fight or flight" response, which is over-activated during opioid withdrawal. However, clonidine does nothing to reduce drug craving, and is mostly ineffective when used alone.(B) 

"Rapid detox" programs claim to accelerate the process of detox and opioid withdrawal by giving large doses of opioid blocking drugs. Some programs place an addict under general anesthesia during the detox process. These programs have not proven to be more effective than traditional methods of detox, and may be more dangerous. (B)

The problem with opiates being used to control pain is that once the painful problem (broke bone) has healed and the need to opiate pain medicine is no longer needed, patients tend to experience a sense of energy or sense of well being from these very same drugs. This is where the addiction begins, as these patients start taking the medication to treat non-medical issues.

 In order to reduce the risk of addiction from body aches such as back pain, arthritis pain, or even pain from surgery, there needs to be drugs that are less addicting and less harmful. The goal is to find a way to manage chronic pain without harming something else within the body (ie the brain circuits).

Chronic back pain may get better with massage, heat, yoga, physical therapy, other non-opiate medications, other non-steroidal medications, muscle relaxants, other classes of medications. Anticonvulsants help with chronic pain [as well as] nerve blocks, injections epidurals, and different kinds of injections and implantable techniques. (C)

Links:
(A)http://www.nytimes.com/2016/05/12/us/opioids-addiction-chronic-pain.html?_r=0
(B) http://www.webmd.com/mental-health/addiction/breaking-an-addiction-to-painkillers-treatment-overvew
(C)http://www.newsmax.com/Health/Health-News/chronic-pain-relief-addiction/2013/12/27/id/544030/

*Please note! These images are not mine. They were found on various tumblr sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~