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” |
{ 6 comments… read them below or add one }
who will probably take the medication as prescribed and for legitmate pain. IMHO, if the pain is bad enough, they will take the medication regardless of their fears. I am glad your doctor is exploring this though, because they should be the first line of information on this topic.
Those I spoke to whose addiction to opioids started with pain medication said that they quickly went from medicating pain to medicating their life. They liked how it made them cope better and began self medicating for a variety of reasons.
A good friend of mine is a doctor who is very knowledgeable about addiction. She recently contacted me to learn more about the TV show House, because she knows I am a fan. The main character is a doctor who is addicted to Vicodin, which he justifies by saying it is for pain management. Some of the episodes have dealt, very graphically, with the consequences of Vicodin abuse and the symptoms he deals with during withdrawal when he does attempt to stop using.
Apparently, many of her patients are refusing prescription pain medications because they are afraid of becoming addicted and ending up like Dr. House. Ironically, I would suspect that many of those people have no idea what addiction is really like and are actually some of the people *least* likely to become addicted.
I went with my ex to the dr. appt. and told them that he had addiction problems. They assured me that they knew how to handle it. Ha Ha. Now that he is 90 days clean he tells me that he has never felt phsycially better. He did have a fusion done on his lower vert. so he had some actual pain. But for months after his surgery he cried and whined about the pain. His mind made him feel that pain but yes, it is amazing what he could do to get Vic. For 1 1/2 years after the fusion he was in the same pain. Ugh! What frustration I had with him. It was my thought, if he could still perform regular activities then he couldn’t really be in that pain. It toom him living on the streets and torn down completely before he sought help. What a vicious path we were on. I HATE VICODIN!!! (I will eventually get over that anger, I am working on it!)
to talk about this or any cut and dry solutions to the problem. I wish you and him the best. Regardless of what happens, he at least now has a choice to make.
This hits home a little too hard. Part of the process that finally got me to recovery was an accident that left me with a partially paralyzed leg and a chronic pain condition called RSD. This is a condition that develops after an injury should stop hurting, and it can be progressive and spread to other parts of the body. So far, and I very grateful, my own problem has remained localized to the damaged leg.
On a daily basis, I have pain that ranges from moderate to severe. It is a burning, insistent type of pain, and it often flares up to the point where it is all I am aware of in my existence. It makes sleeping hard and limits my ability to lead a full life.
When I first sobered up, I spent several months in the hospital and at a rehab center trying to learn to walk on the burning lump my leg had become. I was also learning about AA and serenity. And I was taking a lot of different medications to try and control the pain, which was becoming a real problem. By the time I went home, I had so many prescriptions that I kept them in a small fishing tackle box so that I could keep track of them.
It didn’t take me long to start questioning the value of all of this, especially when I started to research what the pills all were and what they were for. I had some alarming side effects, including horrible vertigo, which encouraged me to keep digging. With the knowledge(not necessarily the approval) of my doctor, I started going off of them, one at a time. And guess what?–my pain stayed the same. The only thing that changed was that I started to feel better in a general sense, and that made it easier for me to learn to cope with the pain I have.
The scariest thing about all of that is the one med I had a hard time letting go off, even though it did not do more for my pain than any of the others. That drug was dilaudid, and I was on both long acting and short term versions of this med. To this day, I can still get it from my doctor and he asks every time I see him if I need it. I have tried to educate him about this, but I think he is doing what he feels is right and he has told me that he thinks I am depriving myself of possible relief because of my history of alcoholism. Its funny he says this, because I have told him it did little to help.
Any way, the point to this long rant is that it is part and parcel of having an addiction problem to learn about any medications you might be prescribed, including pain meds.
I remember my sponsor telling me that any medication was okay–as long as you checked your motivations for taking it. And it is your responsibility to do this–not your doctor’s or your loved one’s. It’s just like anything else in a clean and sober life–the only thing you can truly have control over is yourself.
as it is an entire topic by itself. I think your words convey the strength of your recovery, but I do see those not so confident stress over this issue. This is done often in a future sense as in “I will have to have surgery next month and I know I am going to have to take pain medicine”. It is the nature of our disease to plan for the failure instead of working the solution and this type of situation is fertile ground for relapse.
It would make a great topic, I hope that you will post a blog on the subject.