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Pain Medications and Recovery

By Maia Szalavitz

Winter 1998/1999

People in recovery from addiction are often scared to take pain medication for fear that it will "reactivate" their urges to get high and lead to relapse. Some go so far as to refuse opiate pain killers after major surgery. Some members of 12 Step programs even advise others to forgo medication that their doctors have recommended.

This attitude can be severely destructive. Pain slows the healing process, and untreated pain is more likely to lead to relapse urges than properly treated pain. Even if your drug of choice was heroin or prescription opiates, you should not refuse appropriate, doctor-prescribed medication.

If you have severe, chronic pain and need to take opiates for a long period of time, you may become physically dependent on them and undergo withdrawal when these medications are stopped. People often confuse physical dependence with addiction, but they are not the same thing.

Addiction is compulsive use of a drug despite negative consequences. Dependence is simply needing a drug to avoid physical symptoms. If the consequences of dependence are improved health and decreased pain, it is not addiction. Most painkiller patients who become dependent do not become addicted. Don't let fear of dependence keep you suffering. Using doctor-prescribed medication as prescribed is not a relapse.

Here are some tips for people in recovery for dealing with severe pain.

  1. Tell all your doctors about your history of addiction. That way, they'll be cautious in prescribing. If, however, non-opiate medications aren't effective, don't be afraid to speak up. If a doctor treats this as "drug-seeking," find another doctor. If you're in the hospital and feel that your pain medication is inadequate, ask to speak with the patient advocate or ombudsman.

  2. Explore alternative methods of pain control. Some people find relief with acupuncture, massage, electrical nerve stimulation and other non-drug methods of pain treatment. They can't hurt, and they might help, so may as well try them. However, don't be afraid to admit it if you aren't getting what you need.

  3. See a pain specialist. Physicians trained in pain control are much more likely to know the best way to deal with it than those who haven't worked in this area. Some of it is the opposite of what you'd expect, and there are several new drugs in the pipeline which may offer new ways of relieving pain and which non-specialists may not be aware of.

  4. If you need to use opiates, try to maintain a steady level of pain relief. Research finds that people given opiates on demand are less likely to develop addiction than those who have to wait for medication to be given at a specific time. This is because if you wait in pain for medication, you start to develop a psychological association between the medication and the relief

    Also, the "up and down" feeling is reminiscent of what most addicts experience on the street. If you simply stay at a steady, well-medicated level, you won't have this sensation. Physicians call this type of prescribing PRN. One way of achieving it is with a patient-operated morphine (or other opiate) pump. It sounds strange, but keeping yourself comfortable is less likely to get you in trouble than waiting as long as possible and then taking the drug.

  5. People on methadone may need higher doses of opiate pain killers than others do. Some people wrongly assume that if you are on methadone, you feel no pain and need no pain medication. This is not true, but because of tolerance, methadone patients may need extremely high doses (which could kill others) to get the relief they need. Again, don't be afraid to ask if you're not comfortable.

  6. Pain medications can interact with HIV medications, particularly protease inhibitors [See our Information sheets on interactions between methadone and HIV medications for more details]. Be sure that all your doctors know about all the medications you're taking. Some HIV medications make painkillers stronger, others make them weaker. Don't take chances if you feel overmedicated or as though your breathing is slower than normal. Seek help, since these may be signs of an opiate overdose.

  7. Tell your sponsor or other recovery support people about your use of pain medications. If you're afraid that you won't take them as prescribed, have a sponsor or friend keep the medication for you and give it to you as needed, keeping in mind that you should try for a steady state. Ask yourself: am I in physical pain or do I just want distraction? If you're honest with yourself, you'll know if you're drug-seeking.

  8. If you attend support group meetings, talk about how you're feeling when you're there. Just talking about pain sometimes helps relieve it because fear and loneliness often make pain worse. Try to attend meetings if at all possible.

  9. Alcoholics Anonymous has a very useful pamphlet, "The AA Member and Other Medications," which describes how members have dealt with the use of antidepressants and pain medication. If someone in the program tells you that, "You to aren't sober, you have relapsed," because you have take pain medication, ask to see their medical license and hand them a copy of the pamphlet for the program's official position on the issue.

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