You have an injury, need an operation, or are in chronic pain that affects your daily life. You need treatment for your pain. But you also have a history of opioid or narcotics addiction and aren’t sure how to handle pain medication.
Opioids are drugs that relax your brain and relieve pain. They are also very addicting. Although doctors are less likely to prescribe them than they used to be, they are still a common choice for pain management. In 2019, more than 150 million opioid medication prescriptions were written in the United States, including:
A history of opioid abuse can make pain management difficult, and not just because of the risk of addiction, says Trent Emerick, MD, program director of the Pain Medicine Fellowship at the University of Pittsburgh / UPMC Pain Medicine Program.
“Yes, there are more inherent dangers, such as taking a drug that can trigger food cravings that you’ve battled so much through recovery,” he says. But past opioid abuse also means you have both a higher tolerance for the drugs and a lower tolerance for pain.
“Whether or not on prescription opioids, you need to have good pain management – or even better pain management than other people who have never taken opioids before,” he says. “Not treating pain and trying to deal with it yourself is probably the highest risk of all.”
Are there alternatives to opioids?
Science shows that taking opioids for more than 3 days greatly increases the risk of addiction. Talk to your doctor to find out if another type of medication might work as well – or better – for your pain. Some alternatives include:
Over-the-counter pain relievers. Research shows that a combination of ibuprofen and acetaminophen is as effective as opioids in controlling pain.
“I can’t say it enough: if, for example, you need medical treatment for pain after a procedure, it is very likely that Tylenol and ibuprofen will take care of it,” says Dr. Tildabeth Doscher. She is an addiction medicine scholar at the University of Buffalo.
Physical therapy. A physical therapist can work with you to create an exercise program to improve your movement and function, and to relieve your pain. They can also give you access to other helpful instruments like hot tubs, ultrasound, and deep muscle massage.
Acupuncture. In this practice, a trained acupuncturist inserts small, thin needles into various places on your skin to interfere with certain pain signals.
Shots or nerve blocks. If you have muscle spasms or nerve pain, injections of local anesthetics or other medications can help short-circuit your pain.
Psychological help. Cognitive behavioral therapy can help “retrain” your brain’s perception of pain.
“Pain psychology services are a huge and growing field in the world of pain management, especially for patients with chronic pain or opiate addiction or abuse after surgery,” says Emerick.
“If you can tele-visit or visit in person once or twice to speak to a psychologist, it can often help …”
Success strategies
In some cases, you and your doctor may decide that opioids are the best way to manage your pain. To reduce both your pain and your risk of addiction:
- Be open about your history of addiction. Have an honest conversation with your doctor at the first opportunity. “You want to make it clear to your providers that this is an issue, and that includes mentioning a family history, since addiction is a hereditary disease,” says Doscher.
- Understand your pain management goals. While fighting pain that is interfering with your daily life is important, you shouldn’t expect to be out of pain, Doscher says. “This notion that we have to be pain-free is a very American thing, but it’s wrong,” she says. “It is a major symptom that tells our body what we can and cannot do.”
- Face your fears. If you are afraid of pain, you will likely feel it more intensely. When you acknowledge that you are going to experience some discomfort, you can help your body cope better with it. “If you are expecting pain and remembering that it is normal and okay, it can actually help to deal with it,” says Doscher.
- Be your own lawyer. Make sure your doctor knows your level of comfort with the medication and set limits that seem safe to you. “You can tell your doctor, ‘I want the minimum dose and no more than 3 days of it. Please don’t refill it for me either, because that’s a problem I’ve had in the past, ‘”says Doscher.
Your doctor should be able to guide you along the path to pain management that feels right for you, says Emerick.
“I see patients who come with a history of opioid abuse and never want to touch them again, so we come up with a plan to avoid opioids with multimodal drugs,” he says. “Other patients are not as concerned about relapse and are more than willing to try opioids as long as they are closely monitored.”
Doscher says that even in critical situations, such as a traumatic injury, there are ways to reduce the risk of addiction.
“In life-threatening emergencies, we can use intramuscular or intramuscular opioids instead of oral options,” she says. “So the risk of overtaking them is zero. We just don’t want to turn this switch back on. “
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