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Persons with an addiction history are not immune from physical pain. Whether it is an acute immediate short term pain situation such as a broken bone, sprain or other soft tissue damage, or a more chronic situation - less likely to heal - such as vertebral degeneration, arthritis or fibromyalgia, pain is as much a fact of life for the recovering person as it is for anyone else. What is different is the perceived risk associated with pain medication.
 
In this brief article I will address some of the concerns recovering addicts have expressed regarding pain medication and share some strategies for addressing those concerns. It is understood that some people are newer to recovery than others and the issues involved in pain management may be a bit different. Moreover, persons recovering from addiction to prescription medication, heroin or alcohol will have more specific and different issues relative to their drug of addiction. Nonetheless, many of the strategies for coping with a serious pain situation in recovery are the same.  
 
Pain itself may have been the gateway into addiction. In the past several years I have encountered over a dozen or so people who came to me for addiction treatment who first became addicted to prescription medication following surgery or an injury. Synthetic narcotic medications (also called synthetic opiates) are extremely effective at reducing post-operative or post injury pain levels. In an acute phase of pain, with the appropriate amount of medication, the side effects of feeling high or mildly euphoric are reportedly less noticed. What may develop though is tolerance for the drug and withdrawal when it is stopped.  
 
The phenomena of tolerance is the same for any drug with addictive potential: it is a physiological adaptation to the substance such that more of it is needed to achieve the same effect, or one simply gets less effect from the same amount. Basically the regular dose stops working so the patient needs more to keep the pain away. The problem here is that at some point no amount of the drug is going to relieve pain or if it does it is not worth the side effects: nausea, itching, constipation, decreased blood pressure etc. And there is such a thing as a lethal dose.  
 
Tolerance for the alcoholic means that it takes 6 drinks to make them feel like 2 used to; for a heroin addict 6 doses to get the effect of 2 and it keeps going up - quantity and frequency increase.  
 
Tolerance is a first cousin to withdrawal. In addition to killing pain opiates, synthetic opiates, alcohol etc. have the effect of requiring many systems in the body (nervous, digestive, circulatory, endocrine) to adapt to their presence. When the substance is reduced or removed suddenly these systems have to re-adapt and it can be extremely uncomfortable. Depending on the substance, nature and extent of the addiction withdrawal can even be fatal. Hence the need for medical supervision when stopping the intake and detoxifying the body. Individuals will sometimes go to great lengths to avoid the return of pain and the discomfort of withdrawing (clinically this is called the ‘withdrawal avoidance behavior’). For prescription drug addicts this is the point at which my clients first reported ‘breaking the rules’ and taking medication in excess of prescribed levels or taking a similar medication without prescription. “The doctor didn’t understand.” Pill takers drank; alcoholics took pills; anything to avoid the pain and very real illness of withdrawal.
 
A colleague of mine who is an addiction medicine specialist suggests that any time a doctor prescribes opiod pain medication they should tell that patient "I am going to addict you" simply to caution the patient and prepare them for the potential tolerance, withdrawal and inclination to avoid withdrawal - by whatever means - which may develop. I think this is not too strong of a warning; if the pain condition warrants the use of such strong medication it also warrants the use of such a strong warning.
 
This does not mean in any way that pain medication in and of itself is bad or that everyone who uses it will develop other symptoms of addiction: craving, loss of control, use despite adverse social and personal consequences etc. But it does mean that it places one at risk and that that risk should be acknowledged both by those prescribing and those consuming. The risk is especially relevant to those who already have a history of addiction. 
 
The biggest fear I have encountered with recovering addicts faced with needing pain medication is fear of relapse. For many, sobriety/abstinence has come at a great price; months, even years of ongoing attention and effort have been invested in the process of recovery and the sustained recovery period is of highest value. Many a recovering addict carries a brass metal coin in their pocket with an inspirational message on one side and the number of months or years of continuous abstinence on the other - it represents a healthy source of pride, gratitude and accomplishment. They recoil from the idea of using a potentially addictive medication as they would from any situation which stresses out their program of recovery and rightfully so.
 
But does this mean recovering addicts should never use pain medication? Not at all,, for while the potential to addict is in the pills it is the person themselves who becomes addicted. The pills have no magic power to dissolve a well established recovery and they are not in and of themselves either good or bad. I mentioned above that the risk of pain medication addiction is especially relevant to those who already have a history of addiction. I would add here that the level of awareness of the risk is also greater for the recovering addict and that this awareness can be an asset. Being in recovery from addiction, the addict is actually better informed than the average consumer!
 
During therapy sessions with a recovering addict (12 years) and chronic pain sufferer (3 years) I watched him arrive at the conclusion that living with unmedicated chronic severe pain - if he could do it - permanently and seriously compromised his ability to be useful to his higher power and other addicts seeking recovery - it compromised his 12th step. He had come to me initially for help deciding whether or not he was better off dying than living with the pain, so useless to others did he feel. He made the decision to attempt medicinal treatment of his pain while retaining me as a sort of professional observer - he has done well.
 
At this point let me offer some more specific insights and advice for the recovering person faced with the need for pain management. I have gleaned these over time from clients in my practice.
 
*Consider alternative pain management techniques such as acupuncture, massage, chiropractic, meditation and pain management support groups.
 
* If needing medication be completely open and honest with your physician about your addictive past; if they are not comfortable with this or would prefer not to treat you find one which is aware of addictive issues and work with them.
 
*Start with non-narcotic pain medications first and always take the least amount necessary to cope. With the physicians permission and supervision, under-dose when possible.
 
*Enlist the ongoing support of a significant other - preferably another recovering addict. Arrange it so that they keep the pills and administer them according to prescription. This way it is not you deciding, based on how you feel, that you need a pill or even an extra. This reduces the risk of playing games with the doses.
 
*If you develop a tolerance for the medication suggest your physician consider switching medication before increasing the current dose to the maximum.
 
Addicts who are truly in recovery are not attracted to the anesthetic effects of pain medication: there is no emotional demon inside from which they seek escape. Indeed, the pain medication is not desired and the craving does not develop for there is too much about life which they do not want to miss, a deeper joy or happiness or comfort with self that is attractive to the person.
 
There are those in recovery who will not see a doctor, will not take medication. Certainly Alcoholics Anonymous (A.A.), the progenitor of all 12 step self help groups has no opinion on the matter. It is easier to hold certain opinions about pain and medication when never having been faced with it. Being honest, open minded and willing to learn and useful to others are the hallmarks of any good recovery, even those which must include medication from chronic pain.
 
A friend of mine in recovery learned that I was writing this article for my friends at Wellplace to share with the community and I asked him if he would care to share his very relevant experience with managing pain while in recovery. Below is part of his story.

 
David’s Story
 
I am a recovering alcoholic and my name is David. I was in the program of AA for two years when I developed a rather severe case of degenerative disc disease. I had been in an automobile accident prior to my recovery in AA and this was when I suffered a neck injury which resulted in surgery to correct two ruptured vertebrae. A year or so later, I began to suffer from severe back pain. Upon further study through MRI’s and other bone scans it was determined that I had multiple ruptures and herniations in the thoracic area of my spine. Later, more diseased vertebrae were located in the lumbar region and again in the cervical area of my spine. After multiple surgeries and procedures I was left with a diagnosis of Degenerative Disc Disease and was told that unless something dire happened any more surgeries could do more harm than good. It was at this point in my life I began to experience intractable pain (pain which basically never goes away.) The pain ranges from nagging to excruciating and I was referred to a pain management clinic. Of all the treatments to lesson this pain, the time-released opioid regimen worked the best to relieve my back pain. The irony of this is that the drug used is the same drug that is being misused as a drug of choice for many addicts. Yet with the correct usage of the medicine I am able to single-parent a lovely little girl, maintain a 3.6 GPA in Civil Engineering Technology at a local community college while making a career change, and continue to stay sober in AA while sponsoring other alcoholics and doing service work in the program. I contend that if a person has a workable spiritual connection and follows the principles of AA, any pain medication can be used providing there is a wide chasm separating “needs” from “wants”. That is, if a medication is taken as prescribed for the reason it is prescribed and there are no ulterior motives (we all know what that means), then we can live sober, manageable and productive lives. I have no desire to get high or otherwise change myself for reasons of escape; the medicine does not have that effect on me. The times I have had to take post –operative medications leave me with a feeling of discomfort…in my heart because it is no longer my way of life to feel “out of it”. I feel that once the Third Step “ took me ,” I no longer wanted to run from life and its many vicissitudes. The God of my understanding is in charge and I have no need to attempt to mimic that Higher Power.
 
Many people argue that I am not sober because of my opioid taking. I have been called a drunk on “solid “ alcohol, told I am “chewing my booze” and other not- so- nice epithets. I am not going to argue the point for what I do is for the well being of my family, other recovering alcoholics and myself. My Grandmother used to say, “ There is no need to answer a barking dog.” There are dangers for recovering alcoholics on pain medications .We all know that and I would not want anyone else to have to attempt working the program under the conditions I do. I personally know of two other recovering alcoholics who do have to and it hurts my heart to see them being ostracized by others who are simply ignorant of intractable physical pain caused by some diseases. AA does not take up the argument except to say (and I paraphrase) that when a physician’s help is needed, we probably should use that help. I suppose there are many ways in which to translate the Big Book and the other writings of the AA founders. My lot in life now is to try to “ trudge the road of happy destiny ” and be of service to God and my fellows.
Dr. Timothy Conley holds the degree of Masters in Social Work (MSW) and is Certified as an Addiction Specialist (CAS) with the American Academy of Healthcare Providers in the Addictive Disorders. For the past 15 years, Dr. Conley has been a Licensed Independent Clinical Social Worker (LICSW) and a practicing social work clinician.

In 2001, Dr. Conley received his Ph.D. (Philosophy Doctorate) from Boston College in social work.

Article source: http://www.highlandridgehospital.com/