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Am I an addict? Addiction and Pseudo Addiction to pain killers

Discussion in 'Opiate addiction' started by pathos, Oct 12, 2011.

  1. pathos

    pathos Silver Member

    Reputation Points:
    Jul 5, 2011
    Male from U.S.A.
    I recently posted something about pseudo addiction and it was suggested that it might make a good thread. So, I came across a great deal of information on the subject and chose a few articles that describe it better than I could. Hopefully, I have posted this in the correct forum as I feel it is a highly relevant topic regarding opiate addiction.

    I was originally prescribed methadone with a tiny amount of oxy hcl for breakthrough pain and after a few months on this regimen I decided it was not treating my pain. I looked into methadone for pain relief and spoke with a couple of pharmacists regarding the possibility that it was interfering with the breakthrough medication and I never really got a straight answer.

    I decided, on my own, to stop taking it and see what might happen. Thinking I could just do a quick taper after being on it for months. Big mistake. I went through hellish wd's. At the same time I noticed the other meds began to work. Unfortunately, they only provided limited relief.

    I realized I was simply not getting enough pain relief but was afraid to ask for an increase or change in meds. Fortunately, my PM doc understood that I just needed a boost and upped my breakthrough meds and prescribed something other than methadone for baseline pain control.

    Before the increase my doctor asked why I didn't say anything about the lack of relief sooner and I told him I did not want to appear to be a drug seeker. At that point he took some time to explain dependence, addiction, and something I had never heard of-pseudo addiction. I have been on the new regimen for a while now and feel much better though there are days when nothing works. I have gone to the ER on those occasions and been treated with contempt and suspicion.

    Opiate addiction is a bastard covered bastard with bastard filling. There is a great deal of semantics involved with discussing the use and abuse of substances so this may not be relevant to people who are recovering opiate addicts but I would really appreciate some response to this issue as I still find myself asking, "Am I an addict?" and "Do I need help?" Am I just rationalizing my use of opiates?

    That said, please take a few moments to read this if it is something you have never heard of or might have heard about it and want a little more detail. Like I said, this is just one of dozens of articles, abstracts, and documents that I found on the subject.

    Pseudoaddiction – More Info For The Painies


    Recently I read an article about Pseudo Addiction and Chronic Pain Patients. This information should be helpful for those who suffer the stigma and prejudice drawn from using pain medication. Regularly, Painies are seen as Junkies and/or Drug Addicts. Medical Professionals are hesitant to prescribe; while friends and family are afraid of medications.
    Sometimes, the “Painie” may exhibit behaviours that are of concern. They may be anxious about renewals, dosages and access to Doctors. However, it seems that because Pain Patients may not have the appropriate dosage or access to care, they may exhibit behaviour that may be misconstrued as the actions of a True Addict. The questionable actions go away; once the patient is properly medicated or the pain goes away.

    To provide an understanding for both the Painie and their community, let’s look at the difference between a “True Addict” and a “Pseudo Addict”.

    True Addiction
    Drug addiction is an extremely serious condition. Here is an excerpt from the Mayo Clinic explaining the definition of True Addiction is and some behaviours’. To provide a fuller understanding of Addiction, please click on the additional links.

    By: Mayo Clinic Staff

    Drug addiction is a dependence o a street drug or a medication. When you’re addicted, you may not be able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause and intense craving for the drug. You may want to quit, but most people find they can’t do it on their own.

    Not everyone who uses drugs becomes addicted, but for many what starts as casual use leads to drug addiction. Drug addiction can cause serious long term consequences, including problems with physical and mental health, relationships, employment and the law.

    Drug Addiction Symptoms or behaviours Include:

    • Feeling that you have to use the drug regularly – this can be daily or even several times a day
    • Failing in your attempts to stop using the drug
    • Making certain that you maintain a supply of the drug
    • Spending money on the drug even though you can’t afford it
    • Doing things to obtain the drug that you normally wouldn’t do, such as stealing
    • Feeling that you need the drug to deal with your problems
    • Driving or doing other risky activities when you’re under the influence of the drug
    • Focusing more and more time and energy on getting and using the drug.

    You can see the person with a True Addiction would go anywhere and do anything in order to get the drug of choice; criminal behaviour included. Their use of the drug is with complete disregard to their own health and social situation. Loss of family, house, job or friends will not stop their use of the drug.

    Pseudo Addiction

    While some of the behaviours may mimic true Addiction; it is not the same. The salient difference is once the pain stops – so does the behaviour. With a Pseudo Addict – it is usually a case of the chronic pain not being properly treated with medication. psychological factors like fear of pain and/or anxiety about being able to access medication to stop the pain.

    With Pseudo Addiction, the patient may be concerned about the following:

    • When the next dose can be taken
    • When a refill or renewal of a prescription can be completed.
    • If the patient has access to painkillers – i.e. a Dr. or clinic
    • Anxiety about medications – and may seem like obsessive behaviour
    • Constant discussion about pain medication
    • Increased dosages of pain medication.

    This issue is crucial to understand, because it is one of the biggest reasons Painies are isolated. It is beyond me, why people are so judgemental and assuming. Who wouldn’t want the pain to stop? Wouldn’t anyone be afraid if they knew pain was coming and they couldn’t stop it?
    It is unreasonable for anyone to suffer. The medication is there for a reason and because we are in pain, doesn’t mean we should feel it all the time.

    Story Example:
    For those who have to deal with explaining what it is like to require pain medication, this example may be helpful. Just tell them this story and maybe they may have some empathy.

    “Imagine your bare hand 1 inch above a burning flame. You are not allowed to know when you can take it away. You are not allowed to know if the flame will get higher, bigger or hotter. You can’t move your arm, shoulder or any other part of your body. After about an hour you will start to feel pain in your neck, shoulders, arms and hand. You might experience, burning, tingling, numbness, throbbing pain, piercing pain and/or a deep ache. Nope, you can’t move yet. Starting to feel the anxiety? Starting to question when can this stop? How will it stop? What can I do to make it stop?

    Now move on to hour 2 – the deep throws of the pain. You may feel tired, sleepy and/or exhausted. You might feel nausea, sickness, headaches and/or pain in your chest. You may start to feel like you are sweating all over. The pain in your body probably has done an arch – where you stopped feeling the pain for a period of time; that is your endorphins – but wait until hour 3. Emotionally you have probably felt some relief; thinking “this isn’t so bad”, but wait your body has a way of tricking you.

    Hour 3 – the pain is back – your body has burned out it resources and now you have to stay there. You are starting to feel desperate – starting to say in your head over and over “Make it stop, make it stop.” You have probably started to use coping strategies like distraction and meditation. When talking to people now – you probably have lost your train of thought – can’t remember words or phrases. You may feel like you are talking to someone – but the pain has somehow encapsulated you and you feel like you are someone else.

    After Hour 4 – wouldn’t you do anything to take away the pain – even for a minute? Now you are allowed to take your hand away. I bet you have passed out, rubbed your hand, cried, put salve on your hands and anything and everything you could to make yourself feel better. Now imagine someone saying “Just kidding back you go?”
    Imagine that every day – 24 hours a day – 7 days a week. Not knowing when the pain will break, for how long or if ever. Never understanding why it happens and how? Knowing it could come back at anytime. How do you stop it?”


    Pain medication is not the only answer to pain management. Yet, using it shouldn’t make the patient feel ashamed, judged and weak. It may look scary to the Dr., family, friends, colleagues and co-workers when a Painie is desperate to ensure access to medication. It is frightening to watch someone you love, be counting down the days to a renewal. However, the behaviour must be understood by everyone.

    Of all the Painies I know, not one of them is happy about taking the medication. Nor do they feel a Euphoria or “High” sensation when taking the meds. They simply feel some relief from the pain. Why should we not be able to stop the pain? A greater understanding about Pain, Medication and our State of Mind is very important.

    I encourage my readers to go to the links I have provided and/or find some more resources. Discuss these issues with your Physician, your family and friends. Open and honest communication about your Pain Management Strategy will help all of us. Sharing this article and the ones linked would be a great start.

    WITHIN IN THE UNITED STATES, nearly one-third of the population has a substance abuse disorder as defined via the DSM-IV (American Psychiatric Association, 1994). As the population ages and the incidence of pain continues on an upward swing, the association of drug abuse in disease states such as HIV, cancer, liver disease, and infection will affect assessment and management parameters. Abuse histories complicate provider judgment regarding clinical management of each disease state presented. Over time, inherent problems can occur regarding what the major problem is -- the disease or the potential for abuse. Concern about addiction is a common fear among patients and providers especially when there is an abuse history.
    Studies indicate that only 10% of the patients with substance abuse per DSM-IV are recognized by primary MDs (Caulkner-Burnett, 1994).

    The focus is on the disease state and the substance abuse potential becomes complicated, time consuming, and nonreimbursable. The assumption is if you doubt the truth of the patient history, symptoms and treatment compliance, then back off on the primary therapy indicated (opioids in pain management). Trust and primary care alliances are greatly affected by these assumptions. Manipulative or nontrusting clinical relationships can lead to a cycle of undertreatment, drug abuse, and continued diminished trust (Passik & Portenoy, 1998).

    A great deal of research has focused on substance abuse disorders in the clinically ill (Burton, Lyons, Devens, & Larson, 1991; Colliver & Kopstein, 1991; Gfroerer & Brodsky, 1992). Commonly, the definitions of physical dependence and tolerance in pharmacology become confused with addiction and abuse. Clarity of these terms as they are used in clinical care is critical in managing pain states. Thus, confusion exists related to aberrant drug behavior, undertreatment of pain, and the influence of disease-related impact variables.
    The definition of abuse clearly affects provider perception and clinical care. Abuse is the use of an illicit drug or prescribed drug without medical authorization.

    If compulsive behavior is included, abuse can be assumed per the DSM-IV definitions. Clear abuse includes prescription forgery or IV drug abuse. On the other hand, when medication is prescribed but taken outside the clinical directions, is this abuse? If pain levels increase and medication dosing is increased, is this abuse? How can we categorize these behaviors as abusive in nature? Is it not a response to inadequate clinical management that drives the action? A recent study at Memorial Sloan-Kettering Cancer Center revealed that 26% of the cancer inpatients borrowed anxiolytics from a family member (Passik & Portenoy, 1998). Is this an example of aberrant drug behavior or a predictive behavior within a compromised population?

    Abuse vs. Addiction

    Painful disease states in populations with known drug abuse are challenging clinicians daily. It is clear from research that patients with unrelieved pain exhibit a higher percentage of illicit drug-seeking behaviors. This causes concern regarding identifying the addicted patient versus the pseudoaddictive patient crying out for improved pain management strategies. If the potential for pseudoaddiction as a diagnosis is a possibility, then the patient with unrelieved pain and high levels of distress must be evaluated.

    Abherrant Drug-Related Behavior Differential Diagnosis

    Anxiety disorder
    Personality disorders
    Psychiatric disorders (compulsion).
    Addiction (criminal issues and substance
    Encephalopathies (confusion regarding treatment
    From Passik & Portenoy, 1998

    Several questions should be addressed to clarify the risk of addiction and abuse:

    1. What are the aberrant drug-related behaviors?

    2. What is the clinical experience in pain patients regarding these issues?
    Are clinicians warranted in their addiction fears or is it a sign of pain undertreatment and lack of knowledge? Studies were completed in chronic nonmalignant pain populations with long-term opioid therapy and it was noted that euphoria was a rare side effect. This pain population with no abuse history is literally at no risk for addiction (Fishbain, Rosomoff, & Rosomoff, 1992; Porter & Jick, 1980; Zenz, Strumpf, & Tryba, 1992).

    When does the clinician draw the line between the provider-patient trusting relationship and illicit drug seeking behaviors? Clearly, it is accomplished by using clinical skills to assess, manage, and treat pain patients well.

    Pseudoaddiction behaviors must be assessed as to cause. It is important to note that substance abuse patients with poorly managed pain states are more likely to have relapses into a substance abuse pattern to "treat their pain states." This population has a high percentage of co-morbidity for depression, anxiety, and personality disorders. Treatment will assist in relapse and decreased pain levels (Khantzian & Treece, 1985).

    Recognizing and Treating Pseudoaddiction
    The key to treating patients exhibiting pseudoaddiction is identifying these behaviors Some indicate a stronger addictive learning than others.

    Drug-Related Behaviors


    -Abuse of alcohol and illicit drugs
    -Repeated dose escalations beyond prescribed
    -Multiple ER and clinical visits via multiple providers
    -Deterioration of work, family, and social interactions
    -Drug hoarding
    -Acquiring opioids from multiple providers and
    -Forgery and stealing or selling prescription drugs

    Less Addictive

    -Drug hoarding
    -Occasional drug escalation
    -Increased anxiety re: signs and symptoms
    -Requesting specific drugs
    From Passik & Portenoy, 1998

    Treatment plans must have a team approach. This should include psychologic evaluation, drug addiction specialist consultation as indicated, written contracts, frequent clinical evaluation, renewal of scripts via face-to-face contact, spot urine toxicology screening, and education of the social support systems for the patients (family, friends). Treatment strategies must be well documented in the patient record. The history and physical must include a substance abuse history and past pertinent pain management information.

    Pain relief in the substance abuse population is marked by multidisciplinary assessment, goal setting, and outcomes achieved. Clear understanding of the patient's individual situation is key to positive management outcomes and minimal pseudoaddictive behavior. Assessment by both pain and addiction specialists will bring two different perspectives. In the long run, patient strengths and the challenges they face are important (Kemp, 1995). The team must handle opioid craving, relapse potential, and inadequate pain treatment (Wesson, Ling, & Smith, 1993).

    Treatment strategies for pseudoaddiction include:

    1. A multidisciplinary team.
    2. A written treatment plan.
    3. Accountability to one provider.
    4. Definition of acceptable behaviors and communication routes.
    5. Use of nonopioid and nonpharmacologic pain treatment options.
    6. Ongoing communication with a knowledgeable team of clinicians.
    Addiction is a rare phenomenon in pain patients with no abuse history but the possible exhibition of aberrant drug behaviors must be acknowledged. These behaviors fall under a differential diagnosis and require careful assessment of the psychological and physical components of drug taking. Regardless of these behaviors, clinicians have a responsibility to increase their pain knowledge in order to decrease the aberrant drug-seeking behaviors due to undertreatment of pain.

    Posted by kathleenhogg

    "There is a great deal of info on Pseudoaddiction and hopefully this article will shed some light on the subject. I have found that MD's in the Pain Management community are far more aware of this phenomenon than GP's. Fortunately my PM doc was well versed on this subject and simply increased my medication saying "as long as you aren't running out early or exhibiting 'some of the behaviors in the aforementioned article', I have no problem with helping you live a more comfortable life." That set my mind at ease but I still have this little voice in my head saying "you don't need this shit you freakin addict."

    Maybe I do maybe I don't. I know life before opiod treatment was unbearable. I tried nearly every non narcotic medication and they just made me sick as hell. I developed a precursor to an ulcer. At that point I decided to take the next step and got into opiate treatment.

    There is a link to a massive article about Howard Hughes and Pseudo Addiction but the link is sketchy and is in pdf format and you need to have current Adobe and Internet Explorer installed on your system to view it".


    Here are some links that will flesh out Pseudo Addiction further:

    http://www2.massgeneral.org/painrelief/Pain Topics/What is Pseudoaddiction.pdf
    http://www.addictionmanagement.org/Pseudoaddiction versus Addiction in a Pain Population.pdf

    Attached Files:

    Last edited: Oct 13, 2011
  2. southern girl

    southern girl Newbie

    Reputation Points:
    Apr 12, 2010
    31 y/o Female from U.K.
    My friend Peaches left me this note:

    I have found this incredibly helpful and actually has given me a boost. I actually a feel less like an addict than I have in a long time. I have actually written down a large portion of your post in my pain diary for my Dr to read on Tues.

    I was just talking to an old friend from Georgia and she confided in me that she was 2wks clean from a pharmaceutical opiate addiction. I then proceeded to tell her about my addiction issues and she asked me if I was snorting them. I said no. Crushing or chewing? Nope. Smoking them? Hell no. So you're taking them as prescribed? Yes. And you know, Im not entirely sure she believed me. Since I use to be a coke-head I dont blame her. Her knowing opiate addiction and the lies that follow in its shadow, I guess I wouldnt believe me either. But anyway, my point was, I felt more like an addict than ever because I felt like she didnt believe me and thought "yeah, sure you're not". Atleast my Dr believes me. She has no reason not to, Ive always told her straight away when Ive used more and/or abused them. Always. Ive never lied to get more pills and she always respected that and said that my honesty was brave.

    I dont quite see it that way but I digress.....

    Anyway. Im still trying to figure out what category I fall in. I really do appreciate this post and I think alot of other pain patients will appreciate this.

  3. Otherside

    Otherside Newbie

    Reputation Points:
    Aug 4, 2010
    50 y/o Male from U.S.A.
    Prescription pain medicine addiction grabs headlines when it sends celebrities spinning out of control. It also plagues many people out of the spotlight who grapple with painkiller addiction behind closed doors.
    But although widespread, addiction to prescription painkillers is also widely misunderstood -- and those misunderstandings can be dangerous and frightening for patients dealing with pain.
    Where is the line between appropriate use and addiction to prescription pain medicines? And how can patients stay on the right side of that line, without suffering needlessly?
    For answers, I spoke with two pain medicine doctors, an expert from the National Institute on Drug Abuse, and a psychiatrist who treats addictions.
    Here are seven myths they identified about addiction to prescription pain medication.
    1. Myth: If I need higher doses or have withdrawal symptoms when I quit, I'm addicted.

    Reality: That might sound like addiction to you, but it's not how doctors and addiction specialists define addiction.
    "Everybody can become tolerant and dependent to a medication, and that does not mean that they are addicted," says Christopher Gharibo, MD, director of pain medicine at the NYU Langone Medical School and NYU Hospital for Joint Diseases.
    Tolerance and dependence don't just happen with prescription pain drugs, notes Scott Fishman, MD, professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis School of Medicine.
    "They occur in drugs that aren't addictive at all, and they occur in drugs that are addictive. So it's independent of addiction," says Fishman, who is the president and chairman of the American Pain Foundation and a past president of the American Academy of Pain Medication.
    Many people mistakenly use the term "addiction" to refer to physical dependence. That includes doctors. "Probably not a week goes by that I don't hear from a doctor who wants me to see their patient because they think they're addicted, but really they're just physically dependent," Fishman says.
    Fishman defines addiction as a "chronic disease ... that's typically defined by causing the compulsive use of a drug that produces harm or dysfunction, and the continued use despite that dysfunction."
    For instance, someone who's addicted might have symptoms such as "having drugs interfere with your ability to function in your role [or] spending most of your time trying to procure a drug and take the drug," says Susan Weiss, PhD, chief of the science policy branch at the National Institute on Drug Abuse.
    "Physical dependence, which can include tolerance and withdrawal, is different," says Weiss. "It's a part of addiction but it can happen without someone being addicted."
    She adds that if people have withdrawal symptoms when they stop taking their painkiller, "it means that they need to be under a doctor's care to stop taking the drugs, but not necessarily that they're addicted.

    Otherside added 0 Minutes and 42 Seconds later...

    2. Myth: Everyone gets addicted to pain drugs if they take them long enough.

    Reality: "The vast majority of people, when prescribed these medications, use them correctly without developing addiction," says Marvin Seppala, MD, chief medical officer at the Hazelden Foundation, an addiction treatment center in Center City, Minn.
    Fishman agrees. "In a program where these prescription drugs are used with responsible management, the signs of addiction or abuse would become evident over time and therefore would be acted on," says Fishman.
    Some warning signs, according to Seppala, could include raising your dose without consulting your doctor, or going to several doctors to get prescriptions without telling them about the prescriptions you already have. And as Weiss points out, being addicted means that your drug use is causing problems in your life but you keep doing it anyway.
    But trying to diagnose early signs of addiction in yourself or a loved one can be tricky.
    "Unless you really find out what's going on, you'd be surprised by the individual facts behind any patient's behavior. And again, at the end of the day, we're here to treat suffering," says Fishman.
    Likewise, Weiss says it can be "very, very hard" to identify patients who are becoming addicted.
    "When it comes to people who don't have chronic pain and they're addicted, it's more straightforward because they're using some of these drugs as party drugs, things like that and the criteria for addiction are pretty clear," says Weiss.
    "I think where it gets really complicated is when you've got somebody that's in chronic pain and they wind up needing higher and higher doses, and you don't know if this is a sign that they're developing problems of addiction because something is really happening in their brain that's ... getting them more compulsively involved in taking the drug, or if their pain is getting worse because their disease is getting worse, or because they're developing tolerance to the painkiller," Weiss says.
    "We know that drugs have risk, and what we're good at in medicine is recognizing risk and managing it, as long as we're willing to rise to that occasion," says Fishman. "The key is that one has to manage the risks."

    Otherside added 0 Minutes and 51 Seconds later...

    3. Myth: Because most people don't get addicted to painkillers, I can use them as I please.

    Reality: You need to use prescription painkillers (and any other drug) properly. It's not something patients should tinker with themselves.
    "They definitely have an addiction potential," says Gharibo. His advice: Use prescription pain medicines as prescribed by your doctor and report your responses -- positive and negative -- to your doctor.
    Gharibo also says that he doesn't encourage using opioids alone, but as part of a plan that also includes other treatment -- including other types of drugs, as well as physical therapy and psychotherapy, when needed.
    Gharibo says he tells patients about drugs' risks and benefits, and if he thinks an opioid is appropriate for the patient, he prescribes it on a trial basis to see how the patient responds.
    And although you may find that you need a higher dose, you shouldn't take matters into your own hands. Overdosing is a risk, so setting your dose isn't a do-it-yourself task.
    "I think the escalation of the dosage is key," says Seppala. "If people find that they just keep adding to the dose, whether it's legitimate for pain or not, it's worth taking a look at what's going on, especially if they're not talking with the caregiver as they do that."
    4. Myth: It's better to bear the pain than to risk addiction.

    Reality: Undertreating pain can cause needless suffering. If you have pain, talk to your doctor about it, and if you're afraid about addiction, talk with them about that, too.
    "People have a right to have their pain addressed," says Fishman. "When someone's in pain, there's no risk-free option, including doing nothing."
    Fishman remembers a man who came to his emergency room with pain from prostate cancer that had spread throughout his body. "He was on no pain medicine at all," Fishman recalls.
    Fishman wrote the man a prescription for morphine, and the next day, the man was out golfing. "But a week later, he was back in the emergency room with pain out of control," says Fishman. "He stopped taking his morphine because he thought anyone who took morphine for more than a week was an addict. And he was afraid that he was going to start robbing liquor stores and stealing lottery tickets. So these are very pervasive beliefs."
    Weiss, who has seen her mother-in-law resist taking opioids to treat chronic pain, notes that some people suffer pain because they fear addiction, while others are too casual about using painkillers.
    "We don't want to make people afraid of taking a medication that they need," says Weiss. "At the same time, we want people to take these drugs seriously."
    5. Myth: All that matters is easing my pain.

    Reality: Pain relief is key, but it's not the only goal.

    Otherside added 0 Minutes and 47 Seconds later...

    "We're focusing on functional restoration when we prescribe analgesics or any intervention to control the patient's pain," says Gharibo.
    He explains that functional restoration means "being autonomous, being able to attend to their activities of daily living, as well as forming friendships and an appropriate social environment."
    In other words, pain relief isn't enough.
    "If there is pain reduction without improved function, that may not be sufficient to continue opioid pharmacotherapy," says Gharibo. "If we're faced with a situation where we continue to increase the doses and we're not getting any functional improvement, we're not just going to go up and up on the dose. We're going to change the plan."

    6. Myth: I'm a strong person. I won't get addicted.

    Reality: Addiction isn't about willpower, and it's not a moral failure. It's a chronic disease, and some people are genetically more vulnerable than others, notes Fishman.
    "The main risk factor for addiction is genetic predisposition," Seppala agrees. "Do you have a family history of alcohol or addiction? Or do you have a history yourself and now you're in recovery from that? That genetic history would potentially place you at higher risk of addiction for any substance, and in particular, you should be careful using the opioids for any length of time."
    Seppala says prescription painkiller abuse was "rare" when his career began, but is now second only to marijuana in terms of illicit use.
    Exactly how many people are addicted to prescription painkillers isn't clear. But 1.7 million people age 12 and older in the U.S. abused or were addicted to pain relievers in 2007, according to government data.
    And in a 2007 government survey, about 57% of people who reported taking pain relievers for "nonmedical" uses in the previous month said they'd gotten pain pills for free from someone they knew; only 18% said they'd gotten it from a doctor.
    Don't share prescription pain pills and don't leave them somewhere that people could help themselves. "These are not something that you should hand out to your friends or relatives or leave around so that people can take a few from you without your even noticing it," says Weiss.
    7. Myth: My doctor will steer me clear of addiction.

    Reality: Doctors certainly don't want their patients to get addicted. But they may not have much training in addiction, or in pain management.
    Most doctors don't get much training in either topic, says Seppala. "We've got a naive physician population providing pain care and not knowing much about addiction. That's a bad combination."
    Fishman agrees and urges patients to educate themselves about their prescriptions and to work with their doctors. "The best relationships are the ones where you're partnering with your clinicians and exchanging ideas."
    Last edited: Oct 19, 2011
  4. RaoulDuke32

    RaoulDuke32 Silver Member

    Reputation Points:
    Jul 4, 2010
    Male from U.S.A.
    This sounds a little like trying to make black and white what is in reality shades of grey. Its making too big of a dichotomy between users who get their drugs directly from a doctor and those who get them somewhere else. There are plenty of people who use pain pills on a medicinal basis but dont have a prescription for them, and there are also plenty of people who abuse the pills they get from their doctors.

    Being an addict and having legitimate pain issues is very common. Just because you have legit pain issues doesnt mean that you are not using the drugs you are prescribed in an addictive manner.

    The columns of "pro - addiction" and "less addiction" overlap in many places, including drug hoarding, escalation, etc.

    Obviously there are different types of addiction and different degrees. This just seems to me to be a case of different degrees rather than entirely different diseases or addictions.

    Also, most addicts wont do "anything" to get a fix. The idea that a junkie will cut their mothers throat for a fix i think is outdated propaganda.

    I know there are many people with legit pain needs who get treated like addicts when they are just looking for relief. I was one of them, my friend is one of them, so please dont start arguing with me that i dont know what its like. Admittedly, i dont. Your pain is your own, no one can know what its like, and i would never deny anyone the right to relief.

    It just seems to me like this is an effort to placate people into thinking that they arent an addict. You might be a lot less of an addict, but i dont think that makes it a different monster entirely.

    But what do i know? Im just playing Devils Advocate because someone had to.
  5. Liltony420

    Liltony420 Newbie

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    Sep 10, 2011
    Male from Canada
    Tolerance vs Addiction
    Body used to it : Body needs it

    One idea/way to think of it
  6. TheBigBadWolf

    TheBigBadWolf Haughty High-Horse Rider Palladium Member Donating Member

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    Apr 11, 2010
    52 y/o Male from Germany
    I think it is more where dependency mutates to addictive behaviour.

    To find the difference out it is needed to educate painkiller patients about their meds, about how tolerance works and where they can find out if their attitude vs their meds goes in an addictive way.

    This is what pain therapists should have to do to help their patients have an educated and mature way of handling their pain and painkiller issues.

  7. fibromyalgia

    fibromyalgia Silver Member

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    Nov 1, 2012
    57 y/o Male from Australia
    A fascinating, and important thread. Thankyou pathos for putting forth this social / medical situation.

    There has been brought to light personally ways I behave, I've never been a Drug Addict, I suffer from Chronic pain.

    The thin line between looking like a desperate person seeking relief is important, on the one hand an Addict needing to relieve withdrawal, on the other, someone needing to be assured they are prescribed, in adequate time, their pain medication.

    The reason I say anything here is because my Doctor went on holiday this year, and I also had an operation which took a lot of my energy, resulting in cancelling an appointment with my Prescribing Doctor, once he got back from holiday. Generally, if you cancel his bookings are such that it takes a month to get another appointment, or get a cancellation.

    I was Emailing him how much medication I had left.That I would not see him before my Meds ran out. That if he could kindly post out the prescriptions as I was not able, due to the operation to keep the appointment, go and see him.

    When my Doctor SMS'd in response very briefly, "Busy, will attend to your needs soon.", a week and a half after sending three Emails, I really was feeling very afraid. I was meant to be recuperating, not freaking out.

    Another factor was that his behaviour in reaction to me Emailing him, and seeming desperate, and hearing nothing back for over a week was out of character. I felt more humiliated the harder I had to push, it was unfamiliar territory.

    Having said that, this thread has educated me to realise I should not feel guilty because I was unfortunately injured, and need medication for pain.
    Also, I am going to raise the issue that he made me feel very, very vulnerable; not out of spite, but as it is a fact.
    A piece in an ongoing relationship which can be seem as almost the same as an Addict trying to meet up with their dealer.

    Enough, sorry, it was a difficult time.
  8. want2change

    want2change Newbie

    Reputation Points:
    Mar 12, 2014
    Female from U.S.A.
    Pathos- thank you. This is day 1 on this site. I am more confused than anything. Looking forward to understanding more about myself and I appreciate your links.
  9. fibromyalgia

    fibromyalgia Silver Member

    Reputation Points:
    Nov 1, 2012
    57 y/o Male from Australia
    The Pain treatment methods vary quite differntly from one Country to the next.

    As I'm a Disability peensioner in Australia, I do feel I'm looked down on.

    If I had the money for a more 'dedicated Doctor', i.e., someone I paid, I'd be better off certainly.

    I'm having a particularly difficult time at the moment, as the inevitable has happened, the changing of Dr.'s.

    This means convincing someone you don't know, that you have Chronic pain, from an accident twenty years ago.

    In the end records will be transferred, and found, and the hard time will pass.

    I do feel the very interesting articles about 'Pseudo Pain' may have a flaw.

    Essentially you have pain, and appropriate drugs are prescribed. Personally, I don't muck around with my Meds, as i need them to work. A patient can get comfortable and believe since they have pain, and this is verified through the treating Dr. , they never have to feel pain again.

    You have to work on building your pain threshold, and trying to keep at the same level of pain Meds, even lessening them on good days, as they will loose their efficacy over time.

    It can become very easy to abuse your Meds. This is where I feel some Doctors may let us down, with initial education.

    To take your pain meds as prescribed. To understand you will still feel pain, and even learn to control it through learning how not to do actions which aggravate pain. It can take a lot of organising, a lot of training, and thought to control your environment to be friendly, and not have minor household arrangements exasperate.

    I was very interested recently to have my Son say to me, "Dad, I often wait when you're talking because I know you are in pain, and that can confuse your thoughts. Sometimes If I just wait a moment you'll change what you said, and make your statement clearer."
    I felt what a wonderful understanding person, and how true. As the pain signals flood our nervous system, often it is difficult to think clearly.

    Personally I do feel Dr.'s do cause Drug addiction. It can't be helped, they are prescribing addictive drugs, and in Chronic cases it is very likely that what is Pain, and what is withdrawal are simultaneous, when for instance you go without your medication(s).

    I read the articles above with interest, and I understand the mechanisms.

    As long as you have detailed records, and a regular Doctor I feel the case for Pseudo Addiction is very true.
    However, if by circumstance beyong your control, your Dr. is not available, and you present at another, or at a Hospital, you will most likely be treated as an Addict in withdrawal, at least till the appropriate records have been forwarded from your Dr., and contact with them is made.

    Lets not fool around and kid ourselves, over time a Pain patient does get relief from pain from their Meds, but their metabolism also adjusts and becomes dependant upon the pain killer.

    Personally this is how I feel having had a few bad instances where I've run out of meds, and not been able to get to my Dr., or contact them.
    Also, if you find yourself trying to convince a General Practitioner, not a Pain Specialist you have pain, and need your regular medication, the stress will contribute to you seeming a desperate drug addict.

    Just a ramble, and some thoughts. ;)