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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 physical dependency."

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 debilitating symptom.

"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, too."

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 them."

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