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The connection between chronic pain and addiction is real, and it is more common than most people think.
The relationship between chronic pain and addiction is often close; however, not every individual with chronic pain develops an addiction.
Due to the serious nature of the link between chronic pain and addiction, it is important to have open discussions about the link and its impact on making safer decisions and how to find the right help before it becomes unmanageable.
For evidence-based, compliant, and judgement-free addiction treatment options, refer to CT Addiction Medicine, located in Connecticut.
What Is Chronic Pain?
How Does Chronic Pain Lead to Addiction?
Chronic pain that lasts for over 3 – 6 months, and it can occur after an injury, due to a medical issue, be caused by nerve damage, or sometimes occur with no obvious cause.
Chronic pain is very different when compared to how you feel after you cut your finger or strain a muscle because, in these cases, the pain will eventually resolve. In contrast, chronic pain persists.
Chronic pain can be caused by several factors, including but not limited to the following:
- Back and neck injuries
- Arthritis and joints
- Nerve damage, or neuropathy
- Fibromyalgia
- Migraines and headaches
- Cancer-related pain
- Post-surgical pain
Chronic pain is not just a physical problem. It affects mood, sleep, relationships, and the ability to work. Many people with chronic pain also develop depression and anxiety. This emotional suffering makes people more likely to look for fast relief and that is where danger can begin.
This is the key question. The path from chronic pain to addiction is not always obvious, but it follows a clear pattern for many people.
It Often Starts with Prescription Medication
When a physician prescribes opioids to treat long-term pain, they do so to alleviate discomfort. Opioids do relieve pain by interfering with pain signals in the brain; however, they also stimulate the brain’s pleasure centers by causing a release of dopamine which is often referred to as “the feel-good chemical.”
Over time, the brain adjusts. It starts to need more of the drug to feel the same effect. This is called tolerance. Tolerance leads to higher doses. Higher doses lead to dependence. And dependence can turn into addiction.
The Brain Changes
Chronic pain and addiction both change the brain in similar ways. Both conditions affect the same areas; especially the parts that control emotion, decision-making, and reward. When someone is in constant pain, their brain is already under stress. Adding opioids or other substances to that stressed brain makes it even harder to resist cravings later on.
Emotional Pain Adds to the Problem
Chronic pain has left many suffering people without hope of ever having their lives back, resulting in possible discontinuation of their daily activities. Many people cut themselves off from friends and family members, leading to untreated emotional pain and using drugs and/or alcohol for not only physical relief, but also to feel normal, calm, and happy again. This is why chronic pain and addiction are such an interrelated issue on a psychological level.
Signs That Chronic Pain Treatment May Be Turning into Addiction
- Constantly needing more of a drug to achieve the same relief.
- Experiencing withdrawal symptoms after missing a dose.
- Regularly taking medication more frequently than prescribed.
- Constantly thinking about how to obtain more drugs.
- Visiting many different physicians to obtain narcotics.
- Hiding the actual quantity of medication consumed from family members.
- Using drugs to deal with emotions, in addition to pain relief.
- Isolating from family and friends.
- Missing scheduled responsibilities or work-related obligations due to drug use.
- Losing interest in their previous recreational interests.
If any of these indicators apply to you, seek assistance from a specialist in this area, as there is hope for treatment when chronic pain and addiction coincide; however, acting quickly improves prognosis!
The Science Behind the Overlap
Research has indicated that there are common biological bases for chronic pain and addiction.
Furthermore, the National Institutes of Health published research showing that individuals with chronic pain are at significantly higher risk for the development of opioid use disorder than the general population. The risk is highest when opioids have been used for an extended period of time (90 days or longer).
Mental illness and chronic pain maintain a cyclical relationship with each other. For example, depression can cause a lower pain threshold which leads to more intense experiences of pain.
This identifies the cyclical relationship that exists between chronic pain, mental illness and addiction, which speaks to the importance of treating all three issues in combination with one another.
Why Standard Pain Treatment Is Not Enough
The way that chronic pain is treated in healthcare today is substantially based on reducing the physical symptoms associated with that pain by providing medication, physical therapy, or surgical intervention. These three modalities are certainly effective; however, many healthcare professionals do not address the psychological component of chronic pain.
If a person is using opioids to manage depression as much as physical pain, reducing the opioid dose alone will not fix the problem. It may even make things worse in the short term. That is why integrated care combining pain medicine with psychiatric support gets much better results.
Evidence-Based Treatments That Work
There are proven treatments for the overlap between chronic pain and addiction. Here are the main ones:
Medication-Assisted Treatment (MAT)
Medications that have been approved by the FDA are used as a part of the medication-assisted treatment (MAT) to help reduce withdrawal symptoms, cravings and control pain. An example would be the use of buprenorphine, which will not only help with someone that has used an opioid but also can be used to help with pain relief. Another medication that works for patients suffering from chronic pain and substance use disorder is methadone.
Cognitive Behavioral Therapy (CBT)
CBT has been shown to be one of the most useful tools in treating either chronic pain or addiction. CBT can help identify thought patterns that contribute to making pain feel worse and demonstrate new ways to cope with both pain and cravings. CBT will also help address feelings of depression and anxiety, which often accompany people who are dealing with chronic pain
Mindfulness-Based Approaches
People who are practicing mindfulness are able to notice the presence of their pain without having an immediate response of fear or dread. Mindfulness-based stress reduction has been shown through studies to decrease chronic pain significantly compared to pre-treatment levels. Mindfulness also decreases the emotional triggers that create a need for using substances.
Non-Opioid Pain Management
Psychiatric Support
It is imperative that all depression, anxiety, or PTSD that is contributing to pain-related substance use is treated since failure to treat any and/or all of them leads to an increased likelihood of relapse after treatment.
Tips for Patients and Families
If you are currently managing chronic pain, here are some practical steps to protect yourself:
- Talk openly with your doctor about your medication use and any concerns about dependence
- Never increase your dose without medical guidance
- Ask about non-opioid options for pain management
- Get mental health support alongside pain treatment
- Tell a trusted person how you are doing — isolation makes addiction worse
- Know the warning signs and act early if something feels off
For family members, the most important thing is to stay informed and stay connected. People struggling with chronic pain and addiction often feel ashamed. Your non-judgmental support can make a real difference.
Final Words
Chronic pain and addiction have a complicated relationship, and while many people have struggled, there is hope for those who take the first step toward understanding their connection with help and support from others.
Millions of people have successfully navigated their way through chronic pain and addiction with the appropriate intervention, and they want to help you find your way as well.
If you’re living with chronic pain or substance use (or both) and you’re in the state of Connecticut, contact CT Addiction Medicine.
Frequently Asked Questions
Is everyone that uses opioids for chronic pain going to become addicted?
Most people that use opioids as prescribed will not develop an addiction. However, there is an increased risk of opioid addiction for those who take higher doses of opioids or have been using them for a longer time period. There are also certain factors that may increase a person’s risk of developing an opioid addiction, including having a mental illness and/or a previous history of substance abuse. It is critical to monitor your use of opioids and maintain regular contact with your physician.