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If you are experiencing PDU, what do you propose to do about it?
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Usually people begin taking medication to manage physical pain, but at some point, often without realizing it, start using the medication to manage emotional pain as well. Eventually the medications no longer work for long or very well to ease the physical or emotional pain, and the side effects may actually cause more physical and emotional pain. This happens because long-term use of opioids can increase the body’s and brain’s pain signals. This is called pain rebound syndrome or opioid-induced hyperalgesia. In the end, medication use that started as a reasonable treatment approach to relieve suffering can be the cause of problems in all areas of your life.
From this point on, we will use the terms “addiction” and “problematic drug use” or “PDU” interchangeably. Use the term that feels right to you, keeping in mind that regardless of how you choose to label your situation, the principles of pain recovery apply.
Pain and PDU: Four Stories
1. JR had a history of alcohol abuse—twelve to twenty-four beers per day, shots on weekends, blackouts, and a DUI fifteen years ago. He also smoked and snorted one to two grams of cocaine per day for a few years. After his DUI, the court ordered him to attend twelve-step meetings. Much to his surprise, he attended, grew to like the meetings, got a sponsor, and worked the Twelve Steps. His recovery was going well—so well that he got married, got promoted, and was so busy with family and work that he stopped going to meetings. Six months later, he lifted a heavy box in his garage and sprained his back. An MRI showed no significant cause for his pain, and his doctor started him on Lortab and Soma, with Ambien to help him sleep. Before he realized it, he was taking the entire thirty-day prescription in the first nine days, and for the rest of the month he would beg and borrow more drugs, eventually resorting to stealing drugs from his ailing mother or buying them on the street. He would drink when he ran out of pills, which became a more frequent occurrence. Clearly, he had reactivated his addiction and required treatment, which got him reengaged in the recovery process. He also needed to acquire tools to deal with his pain without medications. He admitted that he had been taking the pills for all sorts of reasons, including to relax, to get energy, and sometimes just to get high.
2. Deirdre wonders how this happened to her. She was a regular working stiff, living in a nice house with her husband and two kids. She never used drugs to any great extent; she didn’t like them. She had tried cocaine and pot when she was younger and got drunk on weekends in college but that’s about it. She had hardly had more than a glass of wine with dinner once a month for the past few years. She lost her taste for alcohol when she started taking pain pills. Her mom was a pill addict, and she never wanted to be like her. Then she developed pelvic pain and adhesions after surgery for endometriosis. She found that one or two Lortab in the morning took the pain away and got her going better than a double espresso. So she started using the pills to get going, keep going, and relieve the pain. When the doctor gave her Soma, she could calm down, numb out, and sleep—she was hooked. The pain was a great excuse, and her doctors were perfect accomplices. She progressed from Lortab to Percocet, which she was getting from her pain doctor, internist, GI doctor, and gynecologist, and neither she nor they realized what was happening. She eventually found that chewing the pills gave her a more intense high. A few months ago she started buying from friends, and now she is spending $500 a month on pills. She’s up to twenty pills a day. She knows she is out of control, addicted, and needs help, but she’s mystified—how did this happen to her? After all, it just started with the pain! She’s not even sure if she’s in pain or not anymore.
3. May wants off medications, but feels she is not an addict. She never abused drugs, took anyone else’s prescription, or stole to support herself. Her medications are all prescribed by her doctor. She wants to try going off meds because they have significant side effects—she is not herself. She sleeps a lot and her pain is still pretty bad. The medications don’t work as well as they used to, and she’s taking stronger medications in higher doses. She heard that stopping meds may decrease her pain, although she finds that hard to believe. She developed fibromyalgia ten years ago and has no life. Her husband left and her grown kids don’t come around, and she doesn’t blame them. She sleeps most of the time, and when she’s awake she’s depressed, grumpy, and complaining. And the constipation is killing her! She thinks of an addict as someone who lives on the street. Addicts take medications to get high. They lie, cheat, and steal. She doesn’t do those things. Her dad was an alcoholic and she doesn’t ever want to act the way he did. He was abusive and downright hateful. She never drank because of that, and tried pot only a few times as a kid. She takes no other drugs except what is prescribed. She doesn’t buy that she’s an addict and doesn’t want to participate in addiction treatment, but she wants off the medications and doesn’t know how she’ll be able to live with the pain. She is consumed with fear all the time. She’s angry at herself for not being stronger, at her husband for leaving, and at the doctors for allowing this to happen.
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