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 National Institute on Drug Abuse, and seniors are particularly vulnerable since they often juggle many medications. Those prescription opioids cause more drug overdose deaths than heroin and cocaine combined, according to the Drug Enforcement Administration. (Drowsiness, respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, and coma are among the potential health consequences of abusing the drugs.) Meantime, painkiller-related admissions to state-licensed treatment centers are on the rise, according to a March report.

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 American Pain Foundation, and 42 percent of those sufferers have endured pain lasting longer than a year. For many of these people, prescription opioids like the oxycodone (sold as OxyContin) and hydrocodone (sold most popularly as Vicodin) used by Braa-Heidner, as well as meperidine (sold as Demerol) and others, are very helpful. "I think the fear can be a huge barrier to proper pain control," says Paul Christo, director of the multidisciplinary pain fellowship program at the Johns Hopkins University School of Medicine. So how should you approach using a pain medication to get the relief you need without getting hooked?

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 Congress but never put into action, to monitor opioid prescriptions from state to state. Meantime, after being prompted by the Food and Drug Administration, drug companies are trying to do their part to ease the problem by reformulating drugs to make them more difficult to abuse. An FDA advisory panel recently recommended approving a new formulation of OxyContin that would reduce the amount of medication released when tablets are crushed or chewed -- common methods used by abusers to boost the impact of the drug. (The FDA typically follows the advice of its expert panels.)

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 British Medical Journal found that acupuncture offered only a small level of relief for people with low-back pain, migraines, knee osteoarthritis, and postoperative pain.

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 University of California-Davis School of Medicine.

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 Betty Ford Institute, the nonprofit arm of the treatment center. Traditional 12-step programs are also necessary, he says, because a "major part of recovery is doing work on character defects and lifestyle problems [such as] grandiosity, antisocial activity, cheating, lying -- being unaccountable and irresponsible. They're the things that have to be examined and then put into reverse," says O'Connor.

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.

(c) 2009 U.S. News & World Report