How common is substance misuse pharmaceutical overuse, and dependence among pain populations?
Prescription misuse and substance dependence has been described as an epidemic in some nations and has sparked considerable debate on how to best use these agents for management of pain conditions. Subsequently, substance abuse poses challenges in the treatment of pain. When medications are monitored and taken as prescribed, risk of abuse is low. As patients experience unrelenting and unremitting pain that does not adequately respond to medical treatments, their levels of psychological distress and suffering increase. Over time, their ability to effectively cope with pain and discriminate between emotional distress and physical pain becomes strained, making it easier to use medication to reduce physical pain intensity, alleviate psychiatric distress, and cope with suffering. Although not effective, patients may use alcohol to promote relaxation and sleep disruptions. Risks of using opiates and analgesics in the long-term treatment of pain include changes in drug tolerance, pain sensitivity, and risk of medication misuse. Not surprisingly, many patients express concern of becoming addicted to their medications and are reluctant to take it altogether. Several factors contribute to one’s vulnerability of developing medication dependence, including the type and duration of the condition and treatments, and psychological and familial risk factors. Notably some people do not respond well to non-opioid medications.