Chronic Pain Patients and Addiction

A surprising statistic reveals that only 3.27% to 17% of chronic pain patients develop a full-blown addiction, depending on the study. Personally, I lean towards the lower percentage based on my experiences. Having engaged with numerous chronic pain sufferers in support groups, I have yet to meet anyone grappling with addiction. This doesn’t imply that it doesn’t occur; it’s simply less common among those who genuinely need pain relief.

But how can we differentiate? The truth is, we can’t always know what’s happening in someone else's mind.

I was once engaged to a recovering heroin addict. During a period when I was hospitalized due to illness, he relapsed, consuming fentanyl-laced drugs. Tragically, my mother discovered his lifeless body the following day. This occurred shortly after we had celebrated a handfasting ceremony, just weeks before our planned elopement. He passed away on January 31, 2006, when I was merely 26 years old.

I consider myself fortunate. I have never experienced euphoria or a feeling of intoxication from my opioids, which are potent. For me, the effect is comparable to taking Tylenol. They help alleviate my pain, although the relief is inconsistent. I have never exceeded the prescribed amount, even during my most severe pain episodes.

I understand the risks of overuse, including physical dependency and the possibility of running out of medication, which would lead to painful withdrawal symptoms. Therefore, I adhere strictly to my prescribed dosage. Thankfully, I do not possess an addictive personality, which certainly contributes to my situation. The reality is that most chronic pain patients genuinely require pain management and are deterred from misusing their medications, as that would raise immediate red flags in their medical records.

Prescription Drug Monitoring Programs (PDMPs) now exist to track every opioid prescription in a centralized database. If a pharmacist or doctor suspects someone is "doctor shopping" or attempting to fill prescriptions prematurely, they may label them as an abuser. Even preemptively assuming someone might misuse opioids can lead to a permanent red flag in the PDMP—effectively preventing them from receiving prescriptions in the future, regardless of their pain levels.

When seeking pain medication in an emergency room, many patients face immediate judgment and are branded as “drug seekers.” I’ve overheard such accusations directed at others from behind thin hospital curtains, forcing me to listen to their entire medical history while their loved ones struggle with the emotional toll.

This stigmatization often drives patients to seek relief in more dangerous places when pain becomes unbearable. Many are misinformed about the purpose of pain medications, expecting them to eliminate all discomfort. In reality, opioids were never intended to provide complete relief; if you're feeling euphoric, you've likely taken too much.

Fortunately, my pain has usually been convincing enough that I receive adequate relief once admitted to the hospital. However, during my appendectomy, I was on a low dose of painkillers. The surgeon, who was particularly unyielding, expressed disdain for opioid users and prescribed only a three-day supply post-surgery, regardless of the operation's severity.

Upon waking, I was in excruciating pain. The surgeon insisted that my ongoing medication should suffice. However, the discomfort from the surgery was overwhelming, especially following recent surgeries for a hernia and gallbladder removal.

Emergency department physicians, having encountered numerous addicts seeking opioids, often develop a jaded perspective, making it easier to deny pain relief. A nurse once told me about a hospital known for its lack of empathy, a reputation that had unfortunately spread among the staff. I can confirm this from my own experiences.

Patients in crisis frequently receive red flags without explanation or justification. Merely stating, “I take [specific opioid]; it helps me,” can lead to immediate suspicion and a knee-jerk red flag designation. I know individuals who have faced such unfounded allegations.

I harbor a deep resentment towards pain medication. While I detest my dependency on these drugs for relief, I recognize that they are essential for maintaining a semblance of normalcy in my life. In addition to my bone and joint ailments, I endure multiple autoimmune disorders that inflict severe muscle pain, resulting in full-body peripheral nerve discomfort.

Every nerve ending in my limbs feels as if it’s being stung by fire ants, and even the gentlest breeze against my skin can provoke an overwhelming urge to scream unless I have something to dull the pain signals.

When my pain peaks, I often find myself curled up in bed, whimpering, with little recourse. If I have access to medication, it alleviates about half of my pain—enough to improve my quality of life, but not enough for a full day’s comfort. If I were to lose my insurance or access to my prescriptions, I can’t fathom what I would resort to.

Despite these challenges, my life is not devoid of joy. I strive to maintain a positive outlook, firmly believing that life’s imperfections can still yield beauty. I’m resilient, and though my pain occasionally overwhelms me, I rely on something that is continuously under scrutiny, with patients everywhere facing the threat of sudden medication withdrawal.

We All Wear Masks

Every individual is composed of layers. The personas I adopted at work before my medical retirement differ significantly from those I present at home. I’m Elle—the writer, the chronic pain warrior, the daughter, the friend, the activist, and the partner. I play different roles for different people, which naturally results in varied presentations of myself.

Chronic pain sufferers often engage in a form of masking as both a coping mechanism and a survival strategy. Who genuinely wants to listen to someone who is lying in agony, rocking back and forth, or complaining? I certainly don’t, and those moments encapsulate my internal experience. When alone, I might grimace in pain, but when others are present, I present a façade of normalcy. I smile, maintain composure, and conceal the tremors in my hands.

At times, I wish I could shed this mask, as it is exhausting to maintain. “I’m okay. I’m okay.” I find myself repeating this phrase often. In truth, I am okay, but I’m also not okay. My pain frustrates me; it hurts and brings me down.

While I discuss my pain, I rarely convey how it permeates every moment of my life. I struggle to sit, stand, or lie down comfortably. The last time I achieved a full night’s sleep was in 2015. My discomfort often awakens me, leaving my heart racing and adrenaline surging.

Thus, I mask my reality, pretending that life is both perfect and beautiful. I face my own hurdles, but I refuse to give in to despair. There are signs that someone is masking their pain; they may avoid eye contact, hold their body rigid, or fidget endlessly as they try to find comfort amidst the discomfort.

When someone in chronic pain states, “I’m hurting,” it’s a straightforward acknowledgment of their current state—similar to saying “I’m hungry.” We’re not complaining; we’re simply sharing our baseline of pain tolerance at that moment. It’s essential to remember that the perception of pain as a complaint is a misinterpretation.

Communication is crucial, whether you are a chronic pain patient or someone who cares for someone in pain. Keep in mind that alongside physical pain may come feelings of depression, anxiety, hopelessness, and isolation. Our struggles extend beyond the physical realm; emotions are a reality.

And let me emphasize this—if you ask someone in pain how they are doing, be prepared for an honest response. Don’t react negatively if the answer is unfiltered; it is merely a matter of courtesy.

The support I found through my chronic pain and illness group, The Chronic Collective, has been invaluable. This community offers validation, solutions, camaraderie, and coping strategies. In a world that often feels limiting due to pain, connecting with like-minded individuals has broadened my perspective.

I’m okay.