Anyone with significant experience in the rooms of twelve-step programs has heard the relapse stories of people with long-term recovery. In many of these stories, pain played a starring role. Pain can place people in long-term recovery at great risk for relapse. Pain brings more people into contact with medical professionals than any other problem. The potential for pain-related relapse increases as we age. As we get older we are more likely to become injured and/or ill. With age, there is also more chance we will hurt as a result of general wear and tear on the various systems in our bodies. For those in recovery, including long-term recovery, no one—regardless of socioeconomic status, age, race, gender, sexual orientation, gender identity, spiritual/religious affiliation, etc.—is exempt from potential relapse. Even after five, ten, twenty, or more years of continuous abstinence, relapse back into active addiction is always a possibility. Sometimes when people with long-term recovery relapse they make it back to their twelve-step fellowship, but often they don’t. Some stay lost in active addiction and others die from overdoses, medical complications, or other consequences of their disease.
Acute and Chronic Pain
There are two types of pain: acute and chronic. Acute pain is time-limited. Although it may last several days to weeks, or even a few months, it eventually goes away. Acute pain comes with sprained joints, strained muscles, broken bones, dental problems, cuts, surgeries, infections and a variety of other injuries and conditions. It exists when there has been damage, and as the damage heals, the pain subsides and resolves. Chronic pain continues beyond three to six months, and can be life-long. It is the exaggerated response of the nervous system to damage, but also to other conditions and situations. Often, the pain is out of proportion to the prior injury. Though chronic pain may increase and decrease, it doesn’t go away. The most common medical treatment for pain—both acute and chronic—includes opioid medications (narcotic “painkillers” or narcotics), such as Vicodin, Lortab, Percocet, Oxycontin, and others. Yet, there is no data to support that using opioids beyond three months for chronic pain is effective at making life better. Of course, opioids have the potential to result in loss of control and, eventually addiction. For people in recovery, taking these drugs, even as prescribed, can trip a switch in the brain that re-awakens the sleeping dragon of one’s addiction. This may be true whether or not opioids were part of a recovering person’s active addiction previously.
From Opioids to Heroin
Over the last decade, the increasing use of opioid pain medications has led to a resurgence in heroin use. As people get addicted to opioids—they often end up using heroin, which is cheaper, frequently more easily available, and more potent. According to a July 2015 report by the US Centers for Disease Control and Prevention (CDC), “the strongest risk factor for a heroin abuse/addiction is prescription opioid abuse/addiction. In fact, people who become addicted to prescription opioid painkillers are forty times more likely to become addicted to heroin.” As heroin use increases, more people are dying from heroin overdoses. Heroin-involved overdose deaths nearly doubled between 2011 and 2013; more than 8,200 people died in 2013 alone. For people in recovery from addiction, opioids should be avoided whenever possible. However, there are injuries, illnesses, surgeries, broken bones, and conditions such as kidney stones, that involve so much acute pain that the only way to address this pain effectively is with opioids. Too much acute pain may be harmful to one’s health and may even interfere with the healing process. Tips for people in recovery for dealing with severe pain:
- Tell all your doctors that you are in recovery from addiction. That way, he or she can use that information in determining your course of treatment, including what and how much medication to prescribe. However, it’s important to be aware that you cannot rely on your doctor to truly understand addiction (however skilled and well-meaning he or she may be) or to safeguard your recovery. You are responsible for your recovery.
- Explore and utilize alternative methods of pain treatment as much as possible. Many people find significant relief through acupuncture, acupressure, massage, physical therapy, electrical nerve stimulation, hydrotherapy, ice, heat, chiropractic, hypnosis, guided imagery/visualization, meditation, bio-feedback, reiki, Chi Kung, topical treatments (lidocaine, Voltaren or capsaicin patches or creams), and non-opioid analgesic and anti-inflammatory medications (oral) like ibuprofen, naproxen, or aspirin. Acetaminophen (Tylenol) is also an effective pain reliever.
- Tell your sponsor, family members and other recovery support people about your use of pain medications (of course, this assumes that you are working a program—if not, get busy in recovery). When opioids are part of an acute pain management plan, your sponsor, partner, and appropriate family members should always be informed of the plan. It is best to have your sponsor, family member, or trusted friend keep the medication for you and give it to you as needed.
- Engage in an ongoing searching and honest inventory about your pain level and the need take opioid medications. Ask yourself, am I in physical pain or is my discomfort/pain more about feeling anxious, fearful, frustrated, angry or depressed? Do I just want distraction? Am I looking to catch just a touch of a buzz? If you are truly honest with yourself, you will know if you are taking medications appropriately. Unfortunately, opioids can cloud your ability to be truthful (with yourself as well as with others) so it is best to confer with trusted friends and recovering people.
- Stay connected to your recovery network. If you attend support group meetings, talk about how you are feeling when you are there. As we learn in the rooms of twelve-step recovery, pain (whether physical or emotional) shared is pain lessened. Because anxiety, fear and loneliness often make pain worse, just talking about your pain can help to relieve it. Keep in close contact with your sponsor and recovery support group. Try to attend meetings if at all possible. The number one cause of relapse is disconnection from a support system. When coupled with a painful condition and taking opioids, we have a perfect storm.
As challenging as it can be—with conscious awareness, social support and careful structure—it is possible for people in recovery to navigate episodes of pain in which opioids are required without relapsing and losing their time in recovery. We see it all the time. What are your thoughts on opioid use? Add your thoughts and comments below and follow us on Facebook!