The slippery slope of back pain, medication abuse, and addiction is rarely talked about in earnest because of those who will get defensive or “offended”. In fact I was pondering how to caveat this story properly so that nobody would get their feathers ruffled after I was inspired by my friend’s blog Married to My Ex. But then I thought, “this is a recovery blog, it is written to benefit those affected by addictions” so if you have a problem with this topic because you have back pain but are not abusing drugs then let me put it plainly… THIS IS NOT ABOUT YOU! (but why so defensive?)
There are several reasons why back pain is such fertile ground for drug abuse and eventual addiction. (1)Because back pain is real and all too common, virtually all people over the age of thirty are going to have the natural wear and tear on their back that can cause back pain. (2)Back pain is easy to fake, pain pills are easy to acquire, and (4) prescription addictions are easy to rationalize.
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While those afflicted with prescription pain medicine addictions often have the luxury of not having to enter the seedier side of life to obtain their drugs and therefore avoid the stigma of being an “addict”, they have a few additional hurdles they must jump before seeking recovery. The biggest hurdle is of course rationalizations, both the “I’m in pain so I have earned the right to abuse drugs” and the obvious “it must be OK because my doctor says so”. The latter is made worse by many doctors who are oblivious or complacent to addiction issues.
Complicating matters is the fact that physicians are vastly undertrained in identifying drug abuse. "The average physician gets little training in drug abuse, mainly because drug abuse has only been recently recognized as a health problem," Leshner says. Brown says that some doctors are so concerned about penalties for overprescribing potentially addictive medications that they don't treat patients appropriately. "Other physicians mean well and prescribe the drugs, but don't know the warning signs of abuse," he says. "Then there are those who just can't say 'No' to patients who violate the prescribed plan."~ Appropriate Use Is Key
I recently discussed this topic with clients of a methadone clinic, many who started their journey to addiction after being prescribed pain pills for legitimate injuries. But once addicted, pain management is no longer a priority (just an excuse), feeding the pill addiction supercedes all things in life. One friend told me it is hard to believe someone who claims they are in excrutiating pain can drive for hours trying to score, climb stairs and scale fences when legal drugs aren’t obtainable, and show equal agility in running from the police!
I guess the big question is how do you tell when someone has crossed over from pain management into abuse and addiction? Well its not easy, but there are a few signs to look for including those in the chart below provided by the FDA. My advice, look to see if the patient is obsessed on the drug or actual pain management. Drugs are a big part of pain management, but it also includes other therapy and lifestyle changes. If drugs have become the only aspect of pain management, you may have a problem.
|Pain Patient||Addicted Patient|
|1. Not out of control with medications||1. Repeated request for higher doses or morefrequent prescriptions|
|2. Medications improve quality of life||2. Medications cause decreased quality of life|
|3. Will want to decrease medications if sideeffects are present||3. Medication continues or increases despite sideeffects|
|4. Concern about the physical problem andactive in using other forms of treatment||4. Unaware or in denial about problems andsingularly focused on drug therapy|
|5. Follows the agreement for the use of opiods||5. Does not follow the agreement for use of theopiods|
|6. May have medication left over or request forrefills are consistent with schedule.||6. Does not have medicines left over, losesprescriptions, and always has a “story”|