Narcotic pain pills (hydrocodone, oxycontin, ultram etc.) work well to relieve serious pain, they are also very addictive if used improperly, and the risk of addiction increases dramatically for anyone with a history of substance abuse.
For someone in recovery from addiction and in serious acute or chronic pain, this combination of efficacy and risk poses a real dilemma, and although no one wants to gamble hard earned sobriety, neither is living in pain an acceptable option.
So what to do?
In years past, the answer given at 12 steps meetings and by doctors was, "tough out the pain, and don't risk an addiction." Times and have changed, and medical opinions have too, and most doctors will now recommend potent analgesics to anyone in serious pain, regardless of their past.
Although pain medications with a high abuse potential certainly threaten sobriety, so too does chronic pain, and unremitting and untreated pain can lead to psychiatric distress, and often to relapse. Asking someone to just "tough it out" doesn’t seem an acceptable option anymore.
Unmanaged pain reduces quality of life and threatens sobriety, and so pain should not get ignored; yet this does not automatically mean that narcotic analgesics are needed. Many pain-patients learn techniques, such as yoga, meditation and breathing exercises, that when combined with over-the-counter pain relievers (Acetaminophen, Ibuprofen) offer acceptable pain relief, with no risk of addiction.
For others, only potent drugs will offer any real respite from serious pain, and although behavioral pain management techniques can offer some relief, narcotic drugs are required. For these patients, drugs should be used, but only in a very controlled and limited manner.
Narcotic Pain Pills for Pain Management
For some patients with severe pain, nothing short of opiate type pain pills offers enough pain relief, and there is little sense, or humanity, in living in constant pain. If nothing else will work, and regardless of a personal history with addiction, most people should consider taking the meds.
Anyone concerned about the temptations these drugs will provide would be well advised to discuss systems of access control with the prescribing physician. Narcotic pain medications are quite safe if used exactly as directed for legitimate pain relief, and if you do not exceed the dosage, you are unlikely to develop an addiction.
Your doctor may suggest strategies, such as a limited supply available for purchase, and may also suggest that someone else be appointed the medication dispenser. For greatest safety, a recovering addict should not be the person in possession of the medication. A trusted person (sponsor, family member, friend) can be entrusted with the task of providing pills at prearranged intervals, ensuring that there is no temptation to exceed the recommended dosage.
Don't Just Endure Pain
Few people live the joy and serenity of sobriety while living with untreated pain. Pain lowers quality of life, and can induce relapse - pain should not be ignored.
Behavioral modification techniques for pain management can work well, and a controlled program of limited access for narcotic drugs should eliminate much of the threat of over-use.
Pain Relief Without Drugs
In addition to non intoxicating pain medications such as ibuprofen (which due to their anti-inflammatory properties, can actually work better than narcotics for certain types of pain management) there are certain behavioral techniques that can be learned, and that can have a very positive impact on the perception and sensations of pain.
We experience pain through a psycho–physical context. Our mood and experience interact with physical pain cues, and influence our perception of pain severity.
Mood disorders such as depression or anxiety worsen the sensations of pain, while a positive state of mind can reduce the sensation of pain.
A state of stress can worsen the experience of pain, while a state of relaxation can lessen its intensity. The first sensations of pain can trigger a state of stress – we know what's coming, and we're worried about it – and in fact exacerbate the sensations of pain.
A negative state of mind or state of stress make experienced pain worse, but contrarily, a positive or relaxed state can minimize the sensations of pain, and as such patients can be taught cognitive modification and relaxation techniques that will help to control pain.
In small group classes, or working with a health psychologist, pain-patients learn techniques that help them to relax, physically and mentally, even as pain threatens. Pain patients also learn cognitive behavioral techniques that foster a healthy acceptance of pain. They are taught to accept pain, and work towards minimizing its severity. Pain is not the enemy, it's a part of life, and learning to live with it in a constructive way helps both to reduce pain's severity, and improve general quality of life.
Some techniques used in pain behavioral modification are:
- Muscle relaxation techniques
- Deep diaphragm breathing exercises
- Mediation and yoga
- Muscle strengthening exercises, such as swimming
- Cognitive techniques for stress management
- Therapy for an acceptance of the pain
For some patients, physiotherapy, physical manipulation, electro stimulation and or surgical techniques can also offer pain relief.
Health psychology and the non narcotic management of pain is very much an expanding field, both in professional availability and general acceptance, and your physician should have information on professionals working in your area for a referral.
There are essentially no negative side effects associated with any behavioral modification technique for pain management; and for addicts or alcoholics in recovery especially, very little reason not to give non-narcotic pain management techniques a try. Some may find acceptable relief with only behavioral modification pain management; most will find at least some pain minimization, allowing them to take less of risky narcotic analgesics.
Page last updated Sep 01, 2015
