Back Pain: Medication and Addiction
There are risks involved with prescription drug addiction, specifically narcotic painkillers. In most cases, the benefits of these medications outweigh the risks.
The Effects of Addiction
For the relatively small number of people who do develop a
prescription drug addiction, the effects can be devastating. Miotto says
addiction often sneaks up on people.
"Often, you just start to call in prescriptions early, or
take your spouse's medication, or take the medication when you're not really in
pain, but when you're tired or depressed," says Miotto. "These
behaviors can creep up on people slowly and then, all of a sudden, they have a
The problem is that the people who have a prescription drug
addiction don't realize it. "Addiction is a disease of denial," Miotto
says. It also pushes people to horrible extremes. Miotto knows one patient who
eventually admitted that she pushed for surgery solely because she wanted the
narcotic painkillers she knew she'd get afterward.
For many people, prescription drug addiction can cause a deep
sense of shame that prevents them from getting help.
"Addiction is hard to talk about in normal terms," says
Miotto. "People think of it as evil, as something that leads to lying and
cheating and stealing. But we need to find a way of talking about addiction
that isn't so shameful. We should treat it more like other chronic illnesses,
like cancer or hypertension."
Doctor vs. Patient
In part because of the stigma of prescription drug addiction,
chronic back pain can sour even the best doctor-patient relationships. Over
time, the patient becomes increasingly frustrated by the doctor's inability to
cure his or her pain. Meanwhile, the doctor may become suspicious of someone
who always refills of powerful narcotics.
"Doctors can get afraid when dealing with patients with
chronic pain, because they don't want to be the ones handing out hardcore
painkillers all the time," says Khoo. "But that leads to a lot of
undertreated patients with real back problems. These are people who are in so
much pain that they're just not functional human beings."
Khoo also says doctors may be too focused on trying to figure
out the underlying source of pain while in the meantime ignoring the
"The patient came to see the doctor because of pain,"
says Khoo, "and he doesn't really care about the underlying cause. He
doesn't care whether it's a disc problem or a deformity. He just wants the pain
to go away. So doctors need to concentrate on treating the symptom,
While this situation can be difficult for anyone with chronic
back pain, people with a past history of addiction face the most skepticism
from their doctors.
"I hate to say it, but when people walk in to the doctor
and mention an addiction history, they may not be able to get these
painkillers," says Miotto. "The doctor may just not trust