Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Is Treatment for Chronic Back Pain Creating Addiction, Not Relief?

The dog ate my Vicodin.
An analysis of studies regarding the use of opioids in chronic back pain was published in the January 16, 2007 edition of "Annals of Internal Medicine".

Interestingly, the authors found that opioids may be effective for not more than four months for chronic back pain. But the prevalence of lifetime or current abuse of these drugs can be over 50%. Unfortunately, long-term studies of opioid use in chronic back pain are relatively rare. And it would be just as important to have studies which are able to show the extent of abuse of prescribed pain medication. It is concerning that there are increasing reports of abuse of pain medications, particularly the long-acting drugs.

Back pain is the second most common complaint seen by doctors in the United States. Chronic back pain (pain lasting for more than 3 months) is a complaint seen in 5% to 8% of the general population; but it occurs in about 20% of the working population.

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The treatment of chronic back pain can include exercise therapy, anti-inflammatory medication, anti-depressant medications, acupuncture, massage, and electrical stimulation, to name a few. Despite this array of treatment options, many patients continue to complain of pain, and the doctor will then resort to the prescribing of opioid drugs, even though the authors of the analysis state "we cannot definitively conclude that opioids provide efficacy".

The analysis just published concedes that the treatment of chronic back pain is difficult, even with the many treatment options available. And while it is tempting to use opioids to treat pain in light of the recent negative press about the cox-2 inhibitors (for example, Vioxx) and the more traditional anti-inflammatory medications, alternative treatments should be utilized. Doctors may be unconsciously prescribing an addiction, not a cure.

Of course, it would help a doctor to be able to determine what patient type might be more at risk of substance abuse.

The authors of the "Annals of Internal Medicine" analysis reviewed two studies which considered patient characteristics that may be associated with an increased risk for addiction. Women were more likely than men to underestimate opioid use in one study, resulting, obviously, in the over-use of opioids. In another study, it was shown that the existence in a patient of other illnesses, past episodes of substance abuse, and a younger age were all associated with the abuse of opioid medications.

Doctors AND patients need to be aware of the therapeutic limitations of opioids for chronic pain, just as they must be aware of the limitations of the patients in dealing with the chronic use of such medications.

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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