Pain, Opioids and Addiction Myths and Facts

Below are two WebMD articles debunking a dozen myths about pain, opioids, abuse and addiction.  They contain some good points with which to make an argument for opioids and refute the opiophobes.

Pain and Pain Relief Myths and Facts | WebMD | August 30, 2015

Pain Relief Myth 1: No Pain, No Gain.

This myth persists among bodybuilders and weekend athletes. Yet there is no evidence to support the notion that you can build strength by exerting muscles to the point of pain. A related belief, “Work through the pain,” is also mistaken.

Resting to repair muscles and bring pain relief might not be macho, but it’s a smart thing to do. You may also need to modify your exercise routine with cross training; lighter, more frequent workouts; and proper shoes.  

Pain Relief Myth 2: It’s All In My Head.

Pain is a complex problem, involving both the mind and the body. For instance, back pain has no known cause in most cases, and stressful life events can make it worse. But that doesn’t mean it isn’t real.

Pain is an invisible problem that others can’t see, but that doesn’t mean it’s all in your head.

Pain Relief Myth 3: I Just Have to Live with the Pain.

There are countless options for pain relief. They include relaxation techniques, exercise, physical therapy, over-the-counter and prescription medications, surgery, and complementary treatments such as acupuncture and massage.

It may not always be possible to completely control your pain, but you can use many techniques to help manage it much better.

Pain Relief Myth 4: Only Sissies Go to the Doctor for Pain Relief.

Older adults are more prone than their kids or grandkids to “grin and bear it.” Enduring the occasional headache or minor sports injury is one thing.

But putting up with chronic pain can impair functioning and quality of life. It can lead to depression, fatigue from loss of sleep, anxiety, inability to work, and impaired relationships.

Most pain can be treated effectively and should be. If you are suffering from pain, you owe it to yourself to make an appointment with your doctor. Relief may be just around the corner.  

Pain Relief Myth 5: I’ll Get Addicted to Pain Medication.

Doctors may prescribe narcotics, such as codeine and morphine, if pain becomes severe, such as when treating cancer pain.

Many people fear that they will become addicted to narcotics. Physical dependence is not the same thing as addiction. And, physical dependence isn’t a problem as long as you do not stop taking the narcotics suddenly.

Addiction to narcotics is not usually a problem, unless you have a history of recreational drug or alcohol addiction. If you do, discuss this with your health care provider before starting any pain medicine.

Prescription Pain Medication Addiction and Abuse: Myths, Reality | August 10, 2011  | WebMD

Prescription pain medicine addiction grabs headlines when it sends celebrities spinning out of control. It also plagues many people out of the spotlight who grapple with painkiller addiction behind closed doors.

But although widespread, addiction to prescription painkillers is also widely misunderstood — and those misunderstandings can be dangerous and frightening for patients dealing with pain.

Where is the line between appropriate use and addiction to prescription pain medicines? And how can patients stay on the right side of that line, without suffering needlessly?

Myth: If I need higher doses or have withdrawal symptoms when I quit, I’m addicted.

Reality: That might sound like addiction to you, but it’s not how doctors and addiction specialists define addiction.

Tolerance and dependence don’t just happen with prescription pain drugs, notes Scott Fishman, MD, professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis School of Medicine.

“They occur in drugs that aren’t addictive at all, and they occur in drugs that are addictive. So it’s independent of addiction,”

Many people mistakenly use the term “addiction” to refer to physical dependence. That includes doctors. “Probably not a week goes by that I don’t hear from a doctor who wants me to see their patient because they think they’re addicted, but really they’re just physically dependent,” Fishman says.

Fishman defines addiction as a “chronic disease … that’s typically defined by causing the compulsive use of a drug that produces harm or dysfunction, and the continued use despite that dysfunction.”

Physical dependence, which can include tolerance and withdrawal, is different,” says Weiss. “It’s a part of addiction but it can happen without someone being addicted.”  

Myth: Everyone gets addicted to pain drugs if they take them long enough.

Reality: “The vast majority of people, when prescribed these medications, use them correctly without developing addiction,”

“When it comes to people who don’t have chronic pain and they’re addicted, it’s more straightforward because they’re using some of these drugs as party drugs, things like that and the criteria for addiction are pretty clear,” says Weiss.

“We know that drugs have risk, and what we’re good at in medicine is recognizing risk and managing it, as long as we’re willing to rise to that occasion,” says Fishman. “The key is that one has to manage the risks.”  

Myth: Because most people don’t get addicted to painkillers, I can use them as I please.

Reality: You need to use prescription painkillers (and any other drug) properly. It’s not something patients should tinker with themselves.

“They definitely have an addiction potential,” says Gharibo. His advice: Use prescription pain medicines as prescribed by your doctor and report your responses — positive and negative — to your doctor

Myth: It’s better to bear the pain than to risk addiction.

Reality: Undertreating pain can cause needless suffering. If you have pain, talk to your doctor about it, and if you’re afraid about addiction, talk with them about that, too.

“People have a right to have their pain addressed,” says Fishman. “When someone’s in pain, there’s no risk-free option, including doing nothing.”

 

Weiss, who has seen her mother-in-law resist taking opioids to treat chronic pain, notes that some people suffer pain because they fear addiction, while others are too casual about using painkillers.

“We don’t want to make people afraid of taking a medication that they need,” says Weiss. “At the same time, we want people to take these drugs seriously.”  

Myth: All that matters is easing my pain.

Reality: Pain relief is key, but it’s not the only goal.

We’re focusing on functional restoration when we prescribe analgesics or any intervention to control the patient’s pain,” says Gharibo.

He explains that functional restoration means “being autonomous, being able to attend to their activities of daily living, as well as forming friendships and an appropriate social environment.”

“If there is pain reduction without improved function, that may not be sufficient to continue opioid pharmacotherapy,” says Gharibo. “If we’re faced with a situation where we continue to increase the doses and we’re not getting any functional improvement, we’re not just going to go up and up on the dose. We’re going to change the plan.”

Myth: I’m a strong person. I won’t get addicted.

Reality: Addiction isn’t about willpower, and it’s not a moral failure. It’s a chronic disease, and some people are genetically more vulnerable than others, notes Fishman.

“The main risk factor for addiction is genetic predisposition,” Seppala agrees. “Do you have a family history of alcohol or addiction? Or do you have a history yourself and now you’re in recovery from that? That genetic history would potentially place you at higher risk of addiction for any substance, and in particular, you should be careful using the opioids for any length of time.”

Seppala says prescription painkiller abuse was “rare” when his career began, but is now second only to marijuana in terms of illicit use.  

Myth: My doctor will steer me clear of addiction.

Reality: Doctors certainly don’t want their patients to get addicted. But they may not have much training in addiction, or in pain management.

Fishman agrees and urges patients to educate themselves about their prescriptions and to work with their doctors. “The best relationships are the ones where you’re partnering with your clinicians and exchanging ideas.”

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  1. Pingback: Summary of Posts about the Opioid Crisis | EDS Info (Ehlers-Danlos Syndrome)

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