Opiophobia: Addiction and Pain Management

The purpose of modern medicine is to heal disease and injury and, when this is not possible, to alleviate the symptoms, including pain.  However, some of the drugs that are most effective at treating pain are also the most addictive.  The U.S. Drug Enforcement Administration (DEA) rates the addictive potential of all substances (“Scheduled drugs”) and monitors physicians’ prescribing behaviors for abuse of the system; so much so, in fact, that the term “opiophobia”—or a doctor’s preference to avoid prescribing opiates at all costs to avoid repercussions like revocation of a medical license—has come into being.  This fear has developed, in part, because a number of people have learned to abuse the system and feign severe pain in an attempt to get strong prescription opiates like Vicodin or Oxycontin.  This has made receiving adequate pain management an unfortunate battle for those who are legitimately suffering from chronic pain.

I have been suffering from pain for a long time and am having difficulty finding a doctor who will help.  What should I do?

Ultimately, you will have to accept your physician’s advice—or get a second opinion.  But before you start looking for another doctor, consider the following.  In many instances, pain is not considered “chronic” until it has persisted for 3 months or longer.  So if you’ve only recently started noticing the pain, you may, unfortunately, have to be patient before your doctor will start offering other options.  If you have been experiencing pain for many months, switching doctors frequently may not be the best idea.  Some doctors may be more likely to prescribe stronger drugs if they have developed a relationship with you and understand that you are not simply seeking a quick “high.”  Going to many different doctors and even lying about having seen other doctors might signal someone who is seeking opiates for the wrong reasons.  And, finally, try to do your best to listen to your doctor’s advice.  Patients who are resistant to trying alternatives like physical therapy, less addictive medicines, and minor procedures may get a reputation for being “drug seeking.”

I am a recovering addict with chronic pain.  Are there pain management options for me that won’t lead back to addiction?

Be honest with your pain management doctor about your past struggles with addiction and continue to see a psychiatrist and/or a therapist to handle related issues.  Work with your doctor and try other options before discussing more addictive drugs.  If your physician determines that it is necessary to use an addictive drug, you may be asked to take drug tests after your pain has dissipated.  Many recovering addicts fear stopping pain medication once they have started it because they recall their former experiences withdrawal so discuss any concerns you may have with your doctor as soon as they arise.

My doctor prescribed a Scheduled substance and I am worried that I will become addicted to it. What should I do?

Addiction is based on the medical concepts of tolerance and dependence (Read Talk the Talk: Medical Terminology Defined); not everyone who takes an addictive substance will become addicted to it (Read Response to Substances: Why It Varies by Person).  However, you should mention your concerns to your doctor, especially if someone in your family has had a problem with substances (Read Addiction and Genetics).  In many cases, alternatives like physical therapy, psychotherapy, and less addictive medicines may be available.

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