To someone in significant physical pain, the sooner relief arrives the better. Medication in the form of powerful opiates or opioids offers swift and effective alleviation of pain. However, in some cases this may be the beginning of a potentially fatal attraction. The treatment for the pain may lead to the development of dependency on the prescribed drug, or to addiction.
Pain falls broadly into two categories: acute and chronic. The former is pain that appears to have a specific cause, usually lasts a limited amount of time before dwindling and then disappearing altogether as the cause of the pain is resolved. Acute pain is an alarm signal for the body to do something immediately to address its cause. Chronic pain continues beyond the acute phase for extended periods of time. For some unfortunate people this entails months, if not years, of pain management.
Painkillers requiring no prescription are advised for mild to moderate pain. For much more severe pain, opioids are a potential treatment. Opiates and opioids are now generally referred to uniformly as opioids to take in both naturally occurring forms of the drug (morphine) and partially synthetic (heroin, oxycodone) or fully synthetic versions (fentanyl and methadone). They come in different forms and are known by a variety of generic and brand names. Some are illegal and some legal, which may also be obtained and used illegally.
Opioids come with powerful effects besides the simple alleviation of physical pain. They numb emotional pain too, inducing feelings of pleasure as intense as euphoria. They induce a degree of relaxation that produces a deep sense of calm. The quality of this sensory experience lays down a powerful memory, prompting repetition. In the process, a person may begin a slide into physiological dependency and/or, for some, addiction. Doctors prescribing opioid medication need to be vigilant as regards this risk. What may start as an appropriate treatment for pain due, for instance, to surgery or injury, may end in addiction, whose many potential harmful consequences include fatal overdose.
An early warning sign is when a person or someone close to them notices that they are continuing to take the opioid medication after the pain, for which it was originally prescribed, has gone. Assessment will determine whether the person has to take a higher dose of the drug to achieve the same effect as previously (tolerance) and whether they are experiencing any unpleasant effects (withdrawal symptoms) when they try to cut down or stop; a primary cause of resumption. In assessing for addiction it is necessary to look beyond physiological dependency to the degree of psycho-social attachment to the drug. Has thinking about the drug, obtaining the drug and using the drug begun to take over, replacing other interests and activities? Has it led to behaviour that would have been previously unthinkable, such as “doctor hopping”, conspiring with unethical nurses, purchasing from illegal online sites, prescription forgery or even stealing from friends and family? Is there a feeling of losing control, evoking shame and guilt, leading to secrecy, deception and social isolation? Is it interfering with relationships with friends and family? Does consumption continue despite all the harm clearly being caused to self and others?
For dependency and/or addiction to painkillers two treatment options present. One is the use of a substitute medication reduced over time under medical management in conjunction with psycho-social support as an outpatient or inpatient. The other achieves complete withdrawal from the opioid under close medical supervision while the client engages in a range of targeted therapies to deal with the psycho-social aspects of dependency and addiction. This may most easily and safely be achieved within a fully serviced residential treatment setting with a positive focus on sustainable recovery.
It is vital to remember that a dependency or addiction to opioids may have had its origins in pain management. Alternatives to opioids as a way of dealing with any residual or persistent pain will need to be explored to help guard against relapse.
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