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January W. Payne
Managing Your Pain, Minus Addiction
Michele Braa-Heidner, 47, started taking prescription painkillers in 1995, when she had her wisdom teeth removed. Soon after, she developed a painful spinal condition for which she needed several surgeries -- and more medications. The drugs relieved the pain and "made me feel really good," she says. Soon, she found that she couldn't get through the day without them. "You're almost chasing that first high, [but] you never get it anymore unless you take a huge amount," she says.
Michael Jackson's death has brought renewed attention to prescription drug abuse, which has long been a problem for everyday Americans as well as pill-popping celebrities. About 48 million people, or 20 percent of Americans over age 12, have taken prescription medications -- often, the painkillers called opioids -- for nonmedical reasons, according to the
But while the stories of current and former prescription opioid addicts are frightening, chronic pain experts note that addiction is relatively rare and that these drugs do offer benefits when they are properly prescribed and used. And there is certainly a need for them. More than a quarter of Americans age 20 or older -- more than 76 million people -- say they've experienced pain that lasted longer than 24 hours, according to the
Keeping tabs. First, experts say it's best to stick with one doctor to coordinate your care; that way, she will keep tabs on all the pain medications you're taking. She may also be looking for signs of abuse. Pain specialists can monitor pill use and do urine drug testing to ward off addiction in their patients. They may also require patients to sign treatment agreements that give the doctor permission to take certain steps if he or she suspects addiction -- including talking to family members about suspected abuse, says Howard Heit, a pain management and addiction medicine specialist based in Fairfax, Va.
And there are other systemic measures in place to help curb abuse. By July of this year, 40 states had passed legislation to start prescription drug monitoring programs to keep tabs on when, where, and for whom controlled substances, including opioids, are dispensed. There's even a push to fund a federal program, approved by
If your pain isn't improving, talk to your physician. It's a bad idea to take medications that haven't been prescribed for you, so don't be tempted to use pills intended for a friend or relative. Instead, see if a different medication or dosing schedule might make things better, and be sure to consider alternative ways of managing pain that might work instead of or in tandem with powerful opioids.
Experts say that injections of steroids or other medications, nerve blocks that interrupt pain signals, physical therapy, and psychological interventions such as cognitive behavioral therapy, biofeedback, and guided imagery, as well as other relaxation techniques, can all be beneficial. Acupuncture is another option. It's thought to ease pain by raising the level of endorphins -- the body's natural pain relievers -- in the body, Christo says. "They are released when the body experiences pain, when you sprain your ankle, cut your finger -- in response to injury." The therapy may work for some but isn't a cure-all; a review of 13 studies published in January in the
And while it may sound counterintuitive, people with chronic pain should try to get exercise, both for the same health reasons as everyone else and, specifically, to avoid muscle atrophy. A 2005 study published in the Annals of Internal Medicine found that a supervised, individually tailored exercise program may help both ease pain and improve function. A physical therapist or personal trainer can help.
If you are using prescription opioids, be aware of the different states that your body may experience. Tolerance occurs when the body adjusts to one dosage and needs increasingly more medication over time to achieve the same result. (This also applies to side effects, so if opioids make you itch, for instance, that feeling may go away as your body adjusts.) People should not be overly concerned about developing tolerance to pain medications, because it's a part of taking the drugs, experts say. Users can also experience physical dependence, causing withdrawal symptoms such as diarrhea, perspiration, and abdominal cramping when they abruptly stop taking the medication. It can occur after as few as two days of continuous use; to reduce symptoms, physicians can help you taper off the dosage, says Christo.
Getting help. Addiction is far more serious. It involves compulsive use of the drug, continued use despite harm to a person or loved ones, and cravings for the substance. Not everyone who takes the medicine will get hooked, even with years of use, and there's no sure way to predict who will. Wonder if you have a problem? The hallmarks of addiction are an inability to keep up with work, school, or family matters as a result of drug abuse, and an inability (or refusal) to stop despite those consequences, says Scott Fishman, professor and chief of pain medicine at the
If you suspect that you or a family member might have developed an addiction to prescription opioids, contact a doctor (a personal physician or a local addiction medicine specialist). Some physicians prescribe the medication buprenorphine -- a narcotic sold under the brand name Suboxone that makes it easier to withdraw from prescription opioids -- for outpatient use. This is not a do-it-yourself project; this medication can also be abused and needs to be used under a doctor's supervision. And be sure there's a plan for ending its use. For more severe cases, people may be referred to addiction treatment centers, which offer detox and treatment.
Patients admitted to the Betty Ford Center in Rancho Mirage, Calif., are first put on buprenorphine, then weaned off the drug quickly. "The drug is only a step to facilitate recovery," says Garrett O'Connor, president of the
As for Braa-Heidner, she's stopped using the drugs that got her in trouble. She soon plans to start, with the help of her psychiatrist, slowly tapering off Suboxone. The drug "has helped me in regards to normalizing my life and getting me out of the ups and downs of taking pain meds every four hours, so I am grateful for that," she says. "I am feeling quite good about my life right now, and I am looking forward to succeeding at healing myself and getting off of Suboxone." It's time to put all the drugs aside.
Prescription Opioids
Prescription opioids are a type of pain medication that are commonly prescribed by doctors to treat moderate to severe pain, such as chronic pain, injury-related pain, and pain related to cancer or other medical conditions. They are called prescription opioids because they are only available by prescription and are meant to be used under the guidance of a doctor. Examples of prescription opioids include oxycodone, hydrocodone, fentanyl, and morphine.
While prescription opioids can be effective in treating pain, they also have a high risk for abuse and addiction, and can cause serious side effects, including nausea, constipation, respiratory depression, and in some cases, death. The misuse of prescription opioids has been declared a public health crisis in the United States, and there has been a significant increase in opioid-related overdose deaths in recent years.
For these reasons, prescription opioids should be used only under the close supervision of a doctor and only for the amount of time and at the dose prescribed. Alternative pain management options, such as physical therapy, exercise, and over-the-counter pain relievers, should be considered before starting opioid treatment.
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Be smart if you take prescription opioids or find alternative forms of relief