There’s an important difference normal use of pain medication, being habituated to it, and addiction. My view is that there’s continuum or spectrum between these three states. To know where you are, you need to look for out for different pain pill addiction signs.
Here’s an example. I have a headache (which I don’t get that often) and I look around and find a painkiller. I take one or two pills, my headache goes and I feel great and can get on with my life. When I have a headache again a few months later I think, “Oh, I remember last time that stuff that worked.” I have a preconceived idea this medication worked before which is now strengthening its power or placebo effect. It helps me so that I can get on with my life, and, (here’s the important bit,) I don’t think about it again until the need arises.
This is a wonderful use of medication. It’s a help to make life better and to reduce your suffering. It has no hold over you at all.
That’s the one side of the spectrum – the best use of medication. In the middle is habituation. This is where you start using the medication more and more until it becomes a regular habit. However, there’s no escalation of dose. You find the dose that works for you and take that every day.
The habituation comes in when you have a voice inside which says, “Oh, this stuff is really making me feel better. I am nervous/frightened of coming off it because then I will have more pain.” What you have created (and it is really of your own creation,) is a psychological dependence on the medication itself. That psychological dependence can be very small and not really a big deal, or it can be quite huge. That’s part of that continuum.
Right on the other end is addiction, where there is not only a psychological but there is a physical addiction. The definition I prefer is that addiction is when your neurons, (in other words, the nerves in your mind, spinal cord and body) have become adapted. This happens through a neuroplastic process. They adapt so that they can only function ‘normally’ while you have the drug in your system.
What happens is when you take the drug and you are okay. However when the drug level drops everything else plummets. If you’re using the medication for pain, your pain explodes, your mood drops and you turn on a craving for the medication.
The craving is an emotional and physical construct. You may also turn on a physical fight and flight response which exacerbates the whole thing. This means you become incredibly anxious and feel shaky because you’re making a lot of adrenaline. Blood pressure cand go up and your heart rate begins to race. You’re feeling sweaty, may get diarrhoea, nausea and feel incredibly unwell.
Some high functioning people can be addicted and keep their job and everything else going but it’s pretty hard. For a most people, addiction causes a downward spiral. Their relationships break down, they lose their job, they can’t get money, they may even turn to crime to keep getting to the substance they crave. They deteriorate or disintegrate physically, mentally, emotionally and in every way.
That’s the far end of addiction.
The important thing is that there are certain medications that will create quite a strong psychological dependence, because they work so well. Some possibilities are pregabalin, Lyrica, gabapentin, amitriptyline, duloxetine. These are the substances which we know can make a real difference for people in chronic pain because they quiet the nerves down.
All opioids are highly physically addictive. Well known legal addictive substances include tramadol, all the benzodiazepines and then the two biggies, alcohol and cigarettes. Of course there’s a whole group of illegal addictive substances.
The important thing is to see where you are on this continuum and to recognize that the vast majority of people on pain medications are not physically addicted, but have a psychological dependence to a greater or lesser extent.
If you have a psychological dependence and the pain medication works and you have minimal side effects, who cares? It’s just part of yotoolkitkit. If the medication has significant side effects, then you’re in a difficult position where you have to slowly reduce your dose to find the sweet spot where you’re getting benefit and minimal side effects. It’s important to research that whatever you are taking has no significant long-term side effects.
In fact, interestingly with all the anti-neuropathic medications, (gabapentin, the pregabalin, amitriptyline, nortriptyline and duloxetine,) the research shows there are not a lot of really significant long-term negatives. The side effects usually are just related to quieting down your pain system. You may feel heady, dizzy, you or not able to concentrate. Once you habituate to these medications, many people find the benefits are much greater than the negatives.