Pain And Addiction

Have you ever linked pain and addiction? There is a relationship between the two, but it is a bit more complicated than you might think. 

When you take medications that treat chronic pain, you can develop an addiction to them. However, you can also get addicted to treatments that target emotional pain. The mechanism behind this is complex, and sometimes it might be difficult to understand.¹ 

However, we must offer help and support to individuals going through a complex situation. This article will offer insight into how pain and addiction work separately, and it will also shed light on how these are connected. 

Understanding pain

Pain is an unpleasant sensory sensation you might experience in different forms, including a pinch, a burn, a sting, or an ache. The way you experience these sensations is subjective, so it will vary from person to person. Pain is a protective response of your nervous system, which is trying to trigger a response within your body and warn you of internal or external signals. 

Types of pain

Pain can be classified into:

• Acute pain: it occurs suddenly and happens because of a specific reason, like surgery, physical damage, injury, or disease. It usually lasts for a short period, anywhere between a few hours or weeks, and if the issue continues after this period, it becomes chronic pain. 
• Chronic pain: this type of pain persists over a long time (months or even years), and it can occur even when there is no injury or illness. It is considered a disease which may be negatively impacted by environmental, social, and psychological factors, making the condition worse.²

Causes of pain

Several issues might cause pain, some more obvious than others:

• Physical injuries
• Inflammation 
• Various medical conditions 
• Nerve damage
• Diabetes
• Herpes 
• Psychological factors, such as stress or depression.^1,2

The role of pain management

Pain management or pain relief is important to improve people’s quality of life. A combination of methods can be used to make the pain disappear, or at least bearable:

• Specific medications called analgesics are often prescribed to treat different types of pain
• Physical therapy and exercise can help you move better, have more strength and lower your pain. Physiotherapists can design an appropriate plan for each individual, increasing the likelihood of speedy recovery. 
• Cognitive-behavioural therapy can help you manage your pain by changing your attitude and perception about your discomfort. ³

The nature of addiction

Addiction is a chronic, relapsing condition characterised by the intake of harmful substances or repetition of negative behaviours, which may have a poor impact on your health and social life.

Types of addiction

While there are thousands of addictions, the simplest way to classify them is into two groups: 

• Substance addiction 

A recurring pattern of drug intake is associated with continuous exposure to substances, cravings, and loss of control. According to experts, the most addictive substances are cocaine, alcohol, caffeine, cannabis, opioids, hallucinogens, inhalants, sedatives, anxiolytics, and tobacco.

• Behavioural addiction

Similar to substance addiction, this type also involves excessive and compulsive behaviours that are almost impossible to stop or control. Some behavioural addictions include gambling, overeating, internet addiction, and mobile phone addiction.⁴

How addiction develops

There is a belief that addiction happens because of a lack of willpower. However, the reality is much more complex than that. There is not one single factor that develops into addiction, but a combination of several things:

• Brain chemistry

Substances and compulsive behaviours can activate the brain's reward centre, releasing more dopamine than normal. Dopamine is a chemical used by the brain cells to communicate and make you feel pleasure, which is a motivation to constantly seek that thrill.¹

• Genetics

Research has indicated that genetic factors play a role in increasing predisposition to the condition, especially if a member of your immediate family suffers from this issue.⁵ 

• Environmental factors

Stress, specific life experiences, and social context will increase the risk of suffering from addiction.⁶

The connection between pain and addiction

Self-medication

Patients with chronic pain often self-medicate with analgesics or other substances to relieve their pain. A study observed that individuals in pain used addictive substances, such as marijuana, cocaine, heroin, and alcohol, to relieve their symptoms. Moreover, some of those who were taking opioids and sedatives did not have a prescription, while others indicated using more quantity than recommended by their doctors.⁷ 

Furthermore, research has shown that individuals who suffer from emotional pain caused by mental issues like stress, anxiety or depression turn to substance abuse as a coping mechanism, and they also self-medicate to relieve their negative symptoms and block their pain for a while.⁸

The neurobiology of pain and addiction

If you are suffering from chronic pain and or addiction, a system called the mesolimbic pathway in your brain gets activated. This is one of the biggest systems using dopamine as a form of communication between the brain cells. When the system is exposed to an addictive substance, like analgesics, it releases more dopamine, which consequently activates your reward system and motivation-seeking behaviour.^{1, 9}

The opioid epidemic

As previously mentioned, opioids are often used to manage pain because they have an analgesic effect. They do so by “stopping” your nerves from sending that painful signal through to your body.¹⁰

Opioids are highly addictive, and 16 million individuals worldwide are suffering from this opioid use disorder. This happens due to a misuse of the drug, where patients use them for a longer period than they should. Consequently, individuals develop a high tolerance for the medication, meaning that they need higher doses for it to have its normal effect. As a result, they become more dependent, and if they try to stop taking these drugs, their withdrawal phase will be severe and difficult.¹¹

The opioid epidemic has a negative consequence for individuals. Not only can it lead to overdose, but using these drugs for a long time can cause your pain to go from bearable to severe.¹¹

The dangers of overlapping pain and addiction

Sometimes, the safe use of medications to treat pain might be compromised by misuse and substance abuse. This could lead to some complications like:

• Tolerance, causing reduced response to drugs 
• Dependence is when the body needs the drug to function like usual. Lack of the substance would cause withdrawal symptoms. 
• Longer use of the medication and/or in greater doses
• Side effects of used medication, such as increased sensitivity to pain
• Negative impact on individual’s quality of life and people in their surrounding
• High risk of overdose
• Death.¹²

Prevention

We all suffer from pain at some point during our lives, and while its duration and treatment will vary, it is important to know that some things could reduce the risk of developing an addiction to pain treatments.

To begin, educating patients about analgesics and the consequences of their overuse could prevent them from abusing these medications. In addition, professionals should monitor their patients during treatment and perform the appropriate exams to detect signs of drug abuse.¹⁰

Moreover, as mentioned before, follow-ups need to be done by professionals. If they detect any signs of addiction, an early intervention should be performed by changing the pain treatment and also by taking the appropriate measures to fight the addiction. 

Finally, both healthcare professionals and patients should consider alternative pain management approaches, like acupuncture, physical therapy, electrical stimulation, injections, topical creams, applying heat or ice, or other methods.¹²

Future directions and research

The National Institute of Neurological Disorders and Stroke supports research about pain, pain treatments, and developing new therapies and targets to manage this issue. What is more, several organisations are working to prevent the misuse of opioids by making policy changes and looking at new potential treatments. 

Summary

Pain and addiction can overlap as a consequence of using certain medications, like analgesics, to relieve symptoms. The use of opioids and other substances to reduce pain can increase the release of dopamine, which results in the activation of the reward system of the brain. This enhances motivation-like behaviours as well as pleasant sensations, which is one of the reasons individuals develop substance dependence. Misuse of analgesics might also contribute to this. Thus, alternative management of pain should be considered.

FAQ’s

Can pain become an addiction?

Yes, however, it is not the pain per se that might become an addiction, but the endorphins (hormones) the body releases in response to pain from injury or damage.¹³

Is addiction the avoidance of pain?

Yes, a lot of substance users who suffer from chronic pain use drugs for immediate relief of their symptoms. Moreover, addiction could also be a way of dealing with emotional pain.¹²

What is pain dependence?

Pain dependence happens when a person uses analgesics, or opioids, to treat pain for a long period (longer than they should) and they develop drug tolerance. Pain medication dependence may be both psychological (for example, the urge to take medication, anxiety when the medication is not available) and physical (the body needing the medication to function normally).¹²

Can pain be controlled mentally?

While on certain occasions you might need medications to treat pain, cognitive therapy, meditation, relaxation, mindfulness, and counselling can teach you some techniques and tools to be able to deal with chronic pain.¹²

Is chronic pain a mental health issue?

In some cases, chronic pain might be an underlying symptom of a health issue. However, there are times when the cause of pain is not clear. This can potentially result in some mental-health-related problems like stress, anxiety or depression.¹²