Use or Abuse: Two Sides of the Same Coin
As stated in the Guidelines for Pain Warriors, a letter to concerned fellow chronic pain survivors, it is rewarding to help others explore different coping measures through our books, but I understand coping strategies alone are often not enough. Opioids allow many of us to participate in things we otherwise couldn’t, and in many instances, they are the safest option when the right precautions are taken. But, addiction is a real consequence of those who abuse opioids. The following are examples of behavioral differences between those living with chronic pain, and those living with addiction. Both can be life altering and both deserve appropriate care.
by Dr. Jeffrey Fudin (blogger) and guest,
Dr. Mena Raouf
ATTENTION! Due to the volume of messages I receive regarding interruption or withdrawal of medical care, particularly regarding access to opioid medications, I ask that you READ THE GUIDELINES for PAIN WARRIORS. It will take a village of individuals with first hand information, personal physical evidence to bring effective action. As a volunteer advocate, and with my fingers on the pulse of the community, I understand the crisis those of us living with chronic pain face. You can read more about risk vs. benefits of opioids, the role of NMDA in untreated pain, a summation of the “Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain” from the Federation of State Medical Boards, and more in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection.
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Chronic Pain vs. Addiction Behavior
Medications cause a decreased quality of life.
The person is out of control with medication, i.e. craving, do not take medications as ordered, and have repeated outlandish stories for losing prescriptions.
The person exhibits a wanton disregard for possible damaging effects.
The person is indifferent to considering any untried non-opioid related therapies.
The person is unwilling to undergo new diagnostic tests that could lead to a helpful intervention and they don’t have a reasonable explanation for refusal. (This must be considered in addition to other behaviors, some patients are simply worn out with feeling like a guinea pig.)
The person breaks their opioid contract.
The person is in denial and is unwilling to acknowledge the benefits of integrative care even when there is no reason they can’t. (The opposite of #9 for chronic pain patients.
The Person Living with Addiction
Medications improve the person’s quality of life.
The person manages their medications appropriately.
If the person experiences uncomfortable side effects, they work with the physician to evaluate benefits and risks.
The person is concerned about the source of their pain and wants to know about possible non-opioid interventions. (This does not include refusal to repeat procedures that haven’t worked. Repeating the same thing expecting different results is not reasonable.)
The person wants diagnostic tests to investigate why previous interventions haven’t worked. (One example, a problem in the sacral plexus may be found on a pelvic MRI vs. lumbar spine imaging. Having an additional piece of information guide the physician to target a different area to relieve similar symptoms.)
The person follows the contract for the use of opioids.
The person is proactive in their pain care and is willing to try different self-help measures to find what works for them individually, when possible. They understand mental, emotional, social, and spiritual balance is important to managing physical pain and improving their quality of life (see number one).
The Person Living with Chronic Pain