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Pain Management

Recognizing the Signs of Opioid Addiction

Paul H. Earley, M.D., DFASAM

President, American Society of Addiction Medicine

It is not easy to treat chronic pain or addiction. They are both complex diseases with many underlying causes. Treating them together is an even bigger challenge.

But people who suffer from chronic pain should not give up hope. Everyone responds differently to available treatments, and there is increasing recognition of the need to try multiple approaches until pain is effectively managed.

Risks of opioid pain management

Physicians have learned that using prescription opioids for long-term pain treatment can have significant drawbacks. Paradoxically, such use increases sensitivity to pain in many individuals.

Physical dependence can occur after using opioids for a few weeks and, tragically, some patients go on to develop addiction. Additionally, research shows many types of pain are better treated with physical and behavioral therapy.

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It is often difficult for patients — and their physicians — to know whether opioid medications are causing more harm than good. I start by asking my patients if they are preoccupied with their next dose. Are they worried about having enough pills or, perhaps, tempted to take more than their prescribed dose? 

Family members and friends might tell patients their behavior has changed. I ask if they are staying home, and avoiding social events and activities they once enjoyed. If the answer is yes, a more in-depth inquiry with a medical expert is the next step.

Explore alternatives

Patients who fear going off their medications can start by asking a doctor with experience treating pain and addiction about new strategies. These options range from readjusting their prescriptions and trying non-addictive medications, to exploring physical therapy, massage therapy, and practicing yoga or tai chi. Seeking help from a multispecialty pain center that offers a variety of treatments is often a wise approach.

I am still surprised by how many people’s pain improves after they stop taking opioid prescriptions. More importantly, they are able to be active in the world again and enjoy their lives.

This was the case for a grandmother I treated who became housebound while taking prescription opioids. After working with a physical therapist who had expertise in chronic pain and being carefully tapered off her opioid medications, she was excited about returning to activities that brought her joy. 

She told me that her two young grandchildren were staying at her home for sleepovers. Yes, she said, it was hard to lift them — quickly adding that it was totally worth it!

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