If you are from my generation, you might remember the OxyContin craze when Purdue Pharma was heavily promoting the drug to doctors to treat pain. Coincidentally, the same year Purdue Pharma began marketing OxyContin, an attempt was made to make pain the 5th vital sign. The goal of that campaign was to “make pain assessment and measurement as important a measure of patient wellbeing as the existing four vital signs” (Scher, et al., 2018) which are temperature, pulse rate, blood pressure, and respiration rate. However, “no one has ever died from pain, but people do die from addiction,” remarked The Life Change Center’s Dr. Swanson during a recent Recovery and Company Podcast episode. Luckily medical experts realized more than one percent do get addicted (see Dopesick on Hulu) and physicians are more cautious about prescribing opioids these days.
However, no one likes to be in pain, and sometimes pain is so bad we may feel like we are going to die. Pain is debilitating. This is why opioids are an excellent way to treat acute pain and have been for thousands of years. In addition, synthetic opioids like Methadone and Buprenorphine are great for treating opioid addiction and work well when taken as prescribed. At The Life Change Center, we have seen people drastically improve their lives and get free from heroin and other addictions through the use of these drugs.
The problem is that when treating chronic pain most narcotics and other pain medications are only effective for a few days or weeks at the longest. They generally do not work for long term pain. The reason is because tolerance and dependence set in and we have to take more and more to treat our pain which, of course, can lead to addiction and overdose. I have a friend whose wife was in an accident and became addicted to pain medication. Sadly, her addiction to the medication eventually led to her death.
In 2020 alone over 16,000 people died from prescription drugs (HSS, 2022). This of course begs the question: how does a person deal with pain and not become addicted? Our Executive Director John Firestone shared how Acceptance and Commitment therapy is an extremely valuable technique that helps individuals work on developing a better relationship with their pain. He says sometimes addiction associated with pain becomes complicated because of our internal conflict around the pain we are experiencing. We could be engaged in an inner battle with our pain as opposed to letting is subside naturally which could account for the highs and lows of our pain experience. Part of this therapy involves working toward accepting a life where our pain level is at a three or four as opposed to looking for a life where our pain level is at a zero. He says that it takes a monumental first step because a person has to see themselves as having a problem with the pain pills, or as having an addiction. They need to see themselves as wanting to make this change. Then they can look at the second phase which is developing a better relationship with their pain.
A dear friend mine who almost died from opioid addiction shared a helpful perspective. Her doctor told her: “If you take this drug and don’t really like it, feel tired, and can’t wait to be off it, that is a normal reaction. However, if you take this drug (any mind-altering drug) and you feel amazing, like you have arrived, that is not a normal reaction and you need to be careful because it could be a sign you have a proclivity toward addiction. This made a lot of sense to me as a recovering addict since I never met a drug or alcoholic beverage that I didn’t like…expect that one bad acid trip! Luckily, today my friend is sober and she is a national speaker and recovery advocate.
Another helpful suggestion from Dr. Swanson is to look at how we are functioning rather than looking at pain as the 5th vital sign because anyone who is addicted will tell you they are in extreme pain because they want more pills. He will often ask patients with chronic pain if they would rather have the addiction, or if they would rather have the pain. Remember, people don’t die of pain, but they do die of addiction.
When dealing with chronic pain we need to treat the physical and psychological aspects of pain and pain management. With proper treatment, therapeutic techniques, and medication as carefully prescribed, you can live your best life even with pain.
Scher, C., Meador, L., Van Cleave, J. H., & Reid, M. C. (2018). Moving Beyond Pain as the Fifth Vital Sign and Patient Satisfaction Scores to Improve Pain Care in the 21st Century. Pain management nursing : official journal of the American Society of Pain Management Nurses, 19(2), 125–129. https://doi.org/10.1016/j.pmn.2017.10.010
U.S. Department of Health and Human Services. (2022, February 1). Overdose death rates. National Institutes of Health. Retrieved May 4, 2022, from https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates