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What’s the Relationship Between Chronic Pain and Addiction?

Chronic pain and addiction are two of the most challenging health issues facing many individuals today. Their interrelation creates a complex scenario where pain management can lead to dependency.  

What is Chronic Pain?

Chronic pain is persistent pain that lasts weeks to years and can significantly interfere with daily activities. Unlike acute pain, which is a direct response to injury and is temporary, chronic pain may originate from various causes and often persists even after the injury has healed. 

Image explaining the differences between chronic pain and acute pain

What Causes Chronic Pain?

It’s not always clear what causes chronic pain, but it can happen when a disease or medical condition alters the nervous system. As a result, the body can then feel more sensitive to pain, and certain sensations can last longer or feel more severe than normal. Chronic pain can also result from a serious injury or infection, or even a surgical incision. 

Here are a few examples of medical conditions that cause chronic pain: 

Migraines: While headaches can be an occasional nuisance, migraines are recurring headaches that can last anywhere from a few hours to three days. Migraines affect about 15% of people all over the world. 

Lower back pain (LBP): There isn’t always a cause for lower back pain, but in many cases it’s caused by long-term joint or muscle strain. Although 40 to 90% of people with LBP have no pain after six weeks, chronic LBP lasts more than 12 weeks. 

Arthritis: Arthritis is a disease that affects the joints. Symptoms include swelling, redness and low range of motion. Osteoarthritis and rheumatoid arthritis are the two most common forms of the condition. 

Cancer: Since cancer can be extremely painful, opioids are often chosen to help relieve severe symptoms. 

Fibromyalgia: Fibromyalgia involves musculoskeletal pain throughout the body and tends to heighten painful sensations. People with fibromyalgia experience chronic pain and are more likely to get the condition from child abuse. 

Shingles: Shingles is a viral infection that causes painful rashes and itchy blisters. Shingles comes from the same virus as chickenpox, and you’re more likely to get it if you’re under a great deal of stress or you’ve had a critical injury. 

You should talk to your doctor if you’re experiencing pain that lasts longer than expected. He or she needs to treat it as soon as possible so that the pain doesn’t get worse. 

Understanding Addiction and Substance Use Disorders

The Nature of Addiction

Addiction is a complex condition characterized by compulsive substance use despite harmful consequences. People with substance use disorders have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their lives. 

The Connection to Chronic Pain

Individuals with chronic pain may begin using prescription pain medication as a legitimate therapeutic resource which can sometimes escalate into misuse due to the efficacy of these medications in providing relief. 

Exploring the Link Between Chronic Pain and Addiction

The Role of Prescription Medications in Chronic Pain Management

Chronic pain often necessitates long-term medication management, which can include the use of powerful opioids. These medications are effective in alleviating pain but carry significant risks: 

Over time, individuals may develop tolerance, requiring higher doses to achieve the same pain relief, which can lead to physical dependence. 

Due to their euphoric effects, opioids have a high potential for misuse. Patients may begin to use medication more frequently or in higher doses than prescribed to manage not only physical pain but also emotional distress. 

Commonly Misused Pain Medications

Although medication treatment for pain management can be helpful, certain prescriptions can become addicting, especially opioids. Here is a short list of the most misused prescription meds for pain management: 

  • Oxycodone (OxyContin)
  • Oxycodone/Acetaminophen (Percocet)
  • Hydrocodone/Acetaminophen (Vicodin)
  • Oxymorphone (Opana)
  • Hydromorphone (Dilaudid) 

This is a benzodiazepine (sedative) that’s usually prescribed for anxiety disorders, but it’s also used for several other medical reasons. 

This is a barbiturate used before surgical procedures and to manage insomnia. 

Opioids and the Transition to Addiction

The transition from legitimate opioid use to addiction can be insidious. It often begins with the physical dependence that develops naturally with long-term use. However, psychological dependence can develop when the medication also begins to serve as a coping mechanism for emotional as well as physical pain. 

Neurochemical Factors: Opioids work by mimicking natural pain-relieving chemicals in the brain, binding to receptors that signal pleasure and pain relief. (1) Over time, the brain may reduce its production of these natural chemicals, making the user more dependent on the drugs to manage pain and emotional well-being. 

Withdrawal Symptoms: As physical dependence intensifies, patients may experience withdrawal symptoms when the medication is not taken, including worsened pain, anxiety, irritability, and other flu-like symptoms. These effects can create a compelling urge to continue using opioids to avoid discomfort. 

Treatment Options for Co-Occurring Chronic Pain and Addiction

Effective treatment for individuals experiencing both chronic pain and addiction requires a dual diagnosis approach, recognizing and addressing both conditions simultaneously. 

Detoxification is the first step in treating addiction. It involves medically supervised withdrawal to safely manage the elimination of drugs from the body, addressing both addiction and chronic pain management needs. 

Inpatient Treatment provides comprehensive, residential care for severe addiction and chronic pain, integrating medical management and therapeutic support in a controlled environment. 

Outpatient Treatment offers flexible, non-residential care for managing chronic pain and addiction, allowing individuals to continue their daily activities while receiving necessary medical and psychological support. 

Non-Opioid Alternatives for Chronic Pain

Although opioids are usually the first choice for managing chronic pain, you shouldn’t use them if you’re addicted to them or at risk for developing a dependence. Fortunately, there are other options. However, some of the alternatives listed below might not be effective for your specific severe pain. Chronic pain must be managed carefully and comprehensively since it can affect how you function daily. Talk to your doctor to see what might be the best medication option for you. 

Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs have long been used to manage acute pain, but it usually takes prescription-strength NSAIDs to take care of chronic pain. NSAIDs are usually taken in pill form, but they also come in topical forms like creams and gels. 

Common NSAIDs include: 

  • Acetaminophen (Tylenol) 
  • Ibuprofen (Advil, Motrin) 
  • Celecoxib (Celebrex) 

NSAIDs are also often combined with opioids like oxycodone and hydrocodone to relieve pain, but as opioids can be addictive, use them with caution. 

According to the CDC, exploring non-opioid treatment options such as physical therapy, acupuncture, and certain antidepressants can be also be vital in managing pain without the risk of addiction. (3) 

Sana Lake Recovery in St. Louis is Here to Help

The dual challenges of chronic pain and addiction require integrated care strategies that address both issues comprehensively. For those seeking help in St. Louis, many reputable facilities offer specialized treatment for co-occurring disorders, ensuring a balanced approach to recovery. 

Are you addicted to prescription medication as a result of a medical condition or accident? Don’t worry. Although addiction is a tough disease to fight, it’s not impossible to beat. Sana Lake Recovery Center has the tools you need to escape the cycle of addiction and get you on the right path to long-term recovery. Contact us today to learn more about our services. 

  1. NIDA. 2021, June 1. Prescription Opioids DrugFacts. Retrieved from on 2024, May 15 
  2. Zhang, Q., Sun, H., Xin, Y., Li, X., & Shao, X. (2024). Studies on Pain Associated with Anxiety or Depression in the Last 10 Years: A Bibliometric Analysis. Journal of Pain Research, 17, 133-149. 
  3. Centers for Disease Control and Prevention. (2023, June 14). Nonopioid therapies for pain management. Centers for Disease Control and Prevention. 
  4. Højsted, J., & Sjøgren, P. (2007). Addiction to opioids in chronic pain patients: A literature review. European Journal of Pain, 11(5), 490-518. 
Picture of Ashley Murry LCSW
Ashley Murry LCSW
Ashley Murry, LCSW, is the Chief Clinical Officer at Sana Lake Recovery. She oversees clinical operations, ensuring effective treatment strategies and compliance. Before this, she was Program Director at Gateway Foundation, managing care programs and collaborating with state departments. Ashley has also served as Director of Clinical Services at Treatment Management Company, improving staff retention and clinical standards. She holds a Master's in Social Work from the University of South Florida and a Bachelor's in Social Work from Saint Leo University. She is licensed in Florida, Arizona and Missouri.
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