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Chronic Pain and Opioid Dependency

Updated: Jul 25

Chronic Pain

Chronic pain is persistent, long-term pain lasting for more than twelve weeks. The effects may include changes in appetite and moods, decreased mobility, muscle tension and stress sensitivity. On top of the physical pain, individuals with chronic pain are at a higher risk for mental health disorders and dependency disorders.

Chronic pain can be caused by a myriad of different things, but some factors are:


Health conditions:

  • Trauma (physical/mental)

  • Endometriosis or uterine fibroids

  • Cancer

  • Chronic fatigue syndrome

  • Obesity

  • Multiple sclerosis

  • AIDS

  • Inflammatory bowel disease

  • Interstitial cystitis

Lifestyle:

  • Long-term poor posture or bending

  • Sleeping on a poor mattress

  • Years of improper lifting or carrying heavy objects

  • Wearing high heels

  • Physical injuries

  • Smoking tobacco

Treatment for chronic pain differs based on the cause as well as the level of pain. It can be treated with various kinds of physical therapy like physiotherapy, acupuncture, yoga, or Chi-gong. Psychotherapy has also been shown to be highly effective at managing chronic pain and painful conditions with EMDR and ISTDP as well as ACT being some of the ones that are effective. Lifestyle changes, and mindfulness practices may also be effective. The use of a combination of ice and heat can provide relief as well as over-the-counter medications like acetaminophen (Tylenol) or Ibuprofen (Advil). However, if they are not enough to treat the pain, then stronger medications are prescribed to address the pain and perhaps any accompanying side effects.


The most common are:

  • Anti-inflammatory medications

  • Steroids (Prednisone)

  • Antidepressants

  • Anticonvulsant and anti-seizure medications

  • Muscle relaxers

  • Opioids

Mental Health and Chronic Pain

People with chronic pain are at a higher risk for mental health conditions. They are four times as likely to be diagnosed with depression or anxiety than those without chronic pain. Having chronic pain harmfully impacts daily life; creating an inability to participate in normal activities, like going to work or school, and even doing household chores. This can put a lot of stress and strain on their mental well-being and may cause a reduced quality of life. Medications like muscle relaxers and opioids can be very addictive and can lead to dependency disorders which can also adversely harm one’s mental health.



Opioid Dependency and Chronic Pain

Addiction and chronic pain too often go together. Opioids like hydrocodone and oxycodone, are often prescribed as a last resort because they are so highly addictive. Opioids are highly effective for treating pain; however, they also create extreme relaxation and euphoria. If a patient is prescribed these medications over months or years, it can change their brain chemistry, activating the reward and habit creation circuits.


There is also a point at which increased dosages of pain-relieving medication is no longer functional. With time, the body adapts, and the efficacy of the medication wears off requiring increased doses.


Continued use will increase their tolerance (meaning they need a larger dose to feel the desired effects) and create a dependency on the substance. This means that attempts to stop taking the drug will most likely result in withdrawal symptoms.


Early symptoms of withdrawal include:

  • Agitation

  • Anxiety

  • Muscle aches

  • Increased tearing

  • Insomnia

  • Runny nose

  • Sweating

  • Yawning


Late symptoms of withdrawal include:

  • Abdominal cramping

  • Diarrhea

  • Dilated pupils

  • Goosebumps

  • Nausea

The side effects of withdrawal can push people into drug-seeking behaviours to elevate the symptoms. If a prescription runs out, a person with an opioid dependency may seek out illegal street drugs, like heroin, as a replacement.

Signs of Dependency

  • Shallow or slow breathing rate

  • Physical agitation

  • Poor decision making

  • Abandoning responsibilities

  • Mood swings

  • Irritability

  • Depression

  • Lowered motivation

  • Anxiety attacks

  • The inability to stop taking opioids

  • Using more than the prescribed amount of opioids

Continued use of opioids can worsen chronic pain over time. Therefore it is important to be aware of the signs of opioid dependency. If you or a loved one is suffering from chronic pain causing mental health problems and/or dependency concerns, do not be afraid to seek help and contact a medical health professional or psychotherapist.


www.nominahealth.ca

Chronic Pain and Opioid Dependency