It is a widespread myth (and the reason that millions suffer and go untreated for pain) that a large percentage of true pain sufferers can get addicted, and that's just not true. You can and will likely get Dependent, but Dependence and Addiction are two very different problems.

Addiction is fueled by a psychological need for the drug to escape mental or social pressures - depression, being broke, criminal activity, etc. The list is endless. The difference is the psychological need - patients who are dependent on opiates use them for a valid medical reason that has real physical manifestations. Addicts use opiates to escape their own personal reality, and they're constantly going through highs and lows, while opiate patients are receiving maintenance levels that control their pain.

As a long-term chronic pain patient with over 15 years of dependence myself (you can read my supervisor bio for more detail), as well as a person who has dealt with relatives who have suffered from addiction, I can say with perspective that there is no comparison. Yes, I deal with withdrawal symptoms if I go too long without changing a patch or taking breakthrough meds, but I don't crave it, and I've been able to . I've never felt the need for any drug other than to ease pain, and there are many times I'll use OTC meds rather than breakthrough opiates.

Addiction in opiate patients is less than 1% or 2% if memory serves me right. Research has found over the years that patients who take their meds on schedule rather than wait until the pain is bad enough to warrant taking it, actually use less over time. It took a long time for me to get out of that old habit of waiting until the pain was too bad, but since I've changed I agree with the studies - I use less than I used to years ago before entering formal pain management.

It should be noted that opiate therapy via pain management is not a decision to be taken lightly - it should only be considered if there are no other therapy options that work. It is a Quality of Life decision - once you commit, you can of course stop, but unless you're able to effectively deal with the root cause of the pain, you're back where you started.

There's also the legal aspects, as well as the mental and physical aspects of opiate therapy over the long term. Legally, pain patients are required to sign a contract with their doctor stating that they won't "doctor shop" and only use one pharmacy. Patients who are in real pain don't have an issue with that, and anyone who does doesn't need opiate therapy to begin with. If you're prescribed Schedule 2 opiates (Percocet, Duragesic, OxyContin, Morphine, etc.) then you'll have to see your doctor every month to get new prescriptions - they cannot have refills, and they can't be called in. They can mail them to you, but I like them in my hand.

Physically, opiates cause mood swings and have various other side effects. It's the mood swings that typically alienate friends and family members who aren't educated prior to the patient starting therapy and are thus unprepared for the sudden change in mood. However, having said that, extreme pain 24/7/365 will do the same thing, so it's a 2 way street.

People who aren't knowledgeable about opiate therapy often wonder about being high all the time, and the plain truth is that it just doesn't happen. You might experience it at the outset, but your body becomes tolerant when the drug is in your system all the time. Over the years I've required pretty high doses of opiates, but aside from the pain control, it's like taking aspirin. I WISH I could get a buzz from drinking wine or Jack Daniels, but not to be. Bottom line is that once your body becomes tolerant, aside from the withdrawal tugs if you go too long past your dosage time, you won't really notice any difference other than the pain being relieved. I pretty much have a reasonably normal life - I can drive, work outside, do things I've been able to do for most of my life. The only thing I can't do is go back to my old job, but that's due to the nature of what I used to do.

The attitude in medicine toward opiate therapy has come a long way in the past 10 years, but I still see doctors using the word addiction in place of dependence, and for people like me it's extremely irritating. It does nothing to promote the use of opiates for patients who are in extreme pain and suffering, and there are many who don't come forward for needless fears of becoming addicted.

If you're wondering if it's possible to break dependence after using high levels of opiates, it is. It ain't fun, but it's not as bad as the daily pain. 3 years ago I had another disk collapse at L3/4 (I have Spondylolisthesis, besides stenosis problems and other spinal degeneration issues), and had to increase my opiate levels to the point where I was no longer getting any increased relief, only more side effects. Some of us call it a "ceiling" that you can reach. At that point I was using 2 100mcg Duragesic patches, 100mg Demerol tabs, 30mg MS Contin (morphine timed-release tabs), in addition to my normal breakthrough prescription of Percocet 10/325's. Earlier this year, I'd recovered enough to the point where I spent most of the year lowering my dependence level (incremental dosage lowering), to the point where I was able to stop using anything for a couple of weeks. I did it to assess my true current pain state (which unfortunately isn't as good as I'd hoped), but my point is that I was able to do it using methods I've used for years. It was only the last week of withdrawals that I needed some anti-nausea meds, but other than that it wasn't anything I hadn't experienced before, and I knew what to expect before I started and prepared for it. I've since had to start reusing opiates, and I resigned myself to the possibility that I'd likely be an opiate patient for the rest of my life. But the alternative for me, like many others, is constant agony, and that'll kill your spirit long before your body fails. Again, it's a quality of life decision.

Mental focus and even meditation shouldn't be discounted for therapy either - believe it or not, gaming is a sanctioned form of therapy for me, and is gaining acceptance in pain circles more recently. It doesn't really matter what activity it is, as long as your mind is focused on something other than the pain. Essentially, you're doing mentally what opiates do chemically, which is alter the brain's perception of the pain. If you're not thinking about it, it's not as bad. It's also how I got to be a WA Supervisor - answering questions keeps the mind focused and off the pain.

I had additional training as well, having trained in and taught Karate for several years before I became too ill. The mental focus I learned, as well as the ability to increase my pain tolerance, helped me significantly when the pain became constant and extreme. I do have a meditation routine that I use and used to teach that I still give to people - if you're interested (or anyone else) feel free to email me at my WA email on my Supervisor bio page at the top.

Only you can really assess your pain level, as all pain is individual and subjective to you alone. What may be nothing to me might be excruciating for you or someone else. But it doesn't mean that you're not suffering or don't require help. If you've exhausted other therapies (that are usually temporary at best) then opiate therapy might be an alternative. Remember too the psychological effect that pain has on us - when it hurts, we don't want to be active. But the body needs to be active to release endorphins to help with the pain. That'll only get you so far though - in reality, if you have physical damage or degeneration to the point where surgery is the only option left (which should only be considered when paralysis or loss of mobility is a factor), or nothing else works for more than a few days, then opiates should be considered, but again, not lightly.

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