Does the Subjective Nature of Pain Increase the Risk of Addiction?

Does the Subjective Nature of Pain Increase the Risk of Addiction?

When a patient enters a doctor’s office complaining of pain, he or she is often asked to describe the type of pain and rate its severity from zero to 10, with 10 being the most severe. These self-identified levels can help doctors identify pain, pain causes and course of treatment, but they are often the only source of pain evaluation given or available to patients. As Nancy Neff at the University of Texas at Austin explains, “It is surprisingly difficult to describe how pain feels because each of us experience pain differently…On a 0-to-10 pain scale, one person’s two can be another person’s 10.” While how a person experiences pain is extremely important and determines how much that pain interrupts his or her quality of life, leaving pain determination up to the individual and pain causes unexplored means the patient may be over- or under-medicated for the pain, two conditions that increase the risk of addiction.

It’s Not Only Pain That Is Subjective

Since pain is subjective, it stands to reason that the effects of pain treatment are similarly subjective. The journal Experimental and Clinical Psychopharmacology found that the experiences related to painkiller use are as subjective as pain itself. When providing opioid pain relief to those in substance abuse treatment and those not, they found, “a significantly greater ‘euphoric’ effect of opioids in [substance abuse patients] compared to the controls.” This shows that “a subgroup of patients does develop euphoria when taking opioids for pain, which may be a risk factor for eventual development of prescription opioid addiction…Subjective effects predictive of eventual addiction may include stimulation and other experiences not typically associated with opioids.” Each person experiences pain differently, and each person experiences the effects of pain management and other drugs differently. Those who experience more “side effects” such as euphoria are more likely to become addicted.

Overtreatment of Pain and Addiction

Overtreatment of pain is the most notorious contributor to addiction development. Even when doctors suspect a patient is addicted or at risk for addiction, they will still often prescribe opioids. Part of the reason for this, as explained by Stanford University’s Scope, is because, “Today’s cultural ethos of ‘all suffering should be avoided’ encourages patients to believe that any level of subjective pain is unacceptable, and that doctors have a responsibility to remove the pain, lest the patient, in addition to being in pain, is psychologically traumatized by having to experience pain.” Many doctors are also at the mercy of customer service reviews that impact their success and advancement, while others like the easy, ready answer that painkillers appear to provide. Doctors do not need to continue exploring underlying, subjective causes of pain or offering and evaluating the effectiveness of alternative pain management strategies if they can simply write a prescription that seems to “fix” the problem. This does not mean all blame lies with doctors, as many patients are all too willing to take a pill rather than ask about other options or research the effects of the medications they are given. Reliance on pain medications, even if there is underlying pain that does need to be managed, quickly leads to dependence and addiction.

Under-treatment of Pain and Addiction

The connection between addiction, pain and too much pain medication is clear, but the connection between untreated or under-treated pain and addiction can be just as strong. The University of Texas at Austin explains, “Untreated or undertreated pain can rob people of the ability to function and can cause depression, irritability, sexual dysfunction and disruptions in sleeping, eating and mobility…Pain itself can cause harmful side effects and can affect concentration and mental clarity.” Avoiding addiction does not mean avoiding pain treatment. Those who avoid opioids and other painkilling drugs may quickly turn to self-medicating with alcohol or benzodiazepines to numb or mask feelings of pain, or they may take drugs such as Adderall, amphetamine, cocaine or other “uppers” to combat feelings of depression, trouble concentrating or other side effects of untreated pain. This self-medication, or even prescribed medication, to address side effects without ever addressing or improving underlying concerns begins a slippery slope to overuse of and dependence on alcohol or drugs.

When Addiction and Pain Overlap

Ending dependence on or addiction to painkillers does not mean that pain has to return or go unmanaged. There are medical interventions for pain management that do not rely on opioids, and these include such strategies as corticosteroid injections, nerve blocks and more. Therapeutic methods for pain management may include acupuncture, massage and meditation. You can live both a pain-free and drug-free life, but it takes action and communication. It takes reaching out to a helpline like ours to learn more about pain management and the symptoms of and treatment for addiction related to pain. We are here 24 hours a day to help you find dependence or addiction recovery resources that include the most up-to-date pain management techniques. All calls are free and confidential, so learn more about pursuing a healthy, comfortable life today.