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Painkiller Addiction

by Professor James Elander(more info)

listed in medical conditions, originally published in issue 246 - May 2018

Addiction to painkillers (analgesics) is a major problem that affects up to one million people in the UK,[1] and many more in other countries, including in Europe[2-4]and the USA.[5] There is an internationally recognized epidemic of prescribed opiate addiction.

A big part of the problem is addiction to prescribed opiate analgesics, for which NHS prescriptions increased from three million in 1991 to 24 million in 2016. However, the problem is not confined to prescribed opiate analgesics, for over-the-counter analgesics are also associated with misuse and dependence.

Cover Painkiller Addict from Wreckage to Redemption

https://www.amazon.co.uk/Painkiller-Addict-wreckage-redemption-story/dp/0749958065

The problems presented by painkiller addiction have multiple aspects, including the need to treat newly developed addictions, and compromised pain management for people who began taking analgesics because of chronic pain. People who become addicted to painkillers are not all one group. For example, one recent analysis identified four different categories of dependent analgesic users, who all have different needs in terms of advice and treatment:

  1. People with ongoing pain and analgesic dependence;
  2. People with resolved pain but unresolved analgesic dependence;
  3. People with poorly managed pain whose behaviour merely resembles analgesic dependence;
  4. People without pain who became dependent through using analgesics recreationally.[6]

New forms of treatment are needed for these growing patient groups, and people using analgesics need accessible information and advice to help them assess their risk of dependence and reduce their dependent use while optimising pain management. It is hard to get the right balance between using painkillers in order to manage pain and get on with living on the one hand, and risking becoming addicted to painkillers so that one stops getting the benefits in terms of pain control on the other. Information to help people make better decisions about taking painkillers could help them manage their pain better and reduce the risk of addiction.

GPs, pharmacists, and other health professionals also need help with their work with patients to help them make better decisions about diagnosis, referral and prescribing. So what evidence could materials like that for the general public and health professionals be based on?

Research at the University of Derby can make a start with this, and a report published in 2017 in the journal ‘Pain’ gives an example.This found that there were two simple questions that were highly predictive of people’s level of dependence on painkillers. These were:

  • Would you be unwilling to reduce your pain medication?
  • Do you feel you depend on your pain medication?

If a person answers ‘yes, definitely’ to both those questions, then they are probably at risk of painkiller addiction and could probably do something to reduce their risk. If a person answers ‘definitely not’ to both questions, however, then they shouldn’t worry too much about addiction to painkillers.

These findings came from an analysis of data from nearly 700 people with different types of pain who used different types of painkillers. This involved combining data from three studies by James Elander, Frances Maratos, Derby PhD students Omimah Said and Malcolm Schofield, and undergraduate Psychology students Ada Dys and Hannah Collins. The research was funded by a University Research for Learning and Teaching Fund grant, a British Psychological Society Undergraduate Research Assistantship bursary and a University Undergraduate Research Scholarship Scheme bursary.

The analysis aimed to find key signs of how likely a person is to get addicted to painkillers. Out of a longer list of 47 questions, the two questions shown above were the best predictors of how addicted or psychologically dependent they were on painkillers. These findings build on previous University of Derby research, published in 2014 in the journal ‘Pain Medicine’, which showed that people at risk of painkiller addiction either took more prescription painkillers more often, or had a prior history of substance-related problems, or were less ‘accepting’ of pain, meaning they found it difficult to keep going with everyday activities when in pain.

This showed that there were multiple routes into analgesic addiction, depending on a person’s starting point. People who answer ‘yes’ to the two questions given earlier could then ask themselves some more questions to get a better understanding of how their own addiction to  painkillers might be developing, for example:

  • Am I using strong painkillers more often than I used to?
  • Am I using painkillers a bit like I used to use drugs or alcohol?
  • Am I getting more sensitive to pain, or having more trouble living with it, than I used to?

We have several further projects planned to continue improving our understanding of how painkiller addiction develops and how to help people avoid it, and we hope to use the findings to develop better information and education for people about painkiller addiction.

Until then, someone who worries about their use of painkillers should talk to their doctor or pharmacist, or even a friend or family member, about how their relationship with painkillers may be changing. There are also some useful websites with information about the problem, including the Kathryn Kemp’s website, author of Painkiller Addict - From Wreckage to Redemption.

References

  1. Shapiro, H. (2015). Opioid painkiller dependency (OPD): An overview. Report for the All-Party Parliamentary Group on Prescribed Medicine Dependency
  2. Alho, H. (2013). Prevalence of prescription opioid dependency in Europe and risk factors for abuse. International Society of Addiction Medicine Annual Meeting 2013. http://doi.org/10.1017/CBO9781107415324.004
  3. Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287-333.
  4. Casati, A., Sedefov, R. & Pfeiffer-Gerschel, T. (2011). Misuse of medicines in the European Union: a systematic review of the literature. European Addiction Research, 18, 228-45.
  5. Boyd, C. J., Teter, C. J., West, B.T., Morales, M., & McCabe, S.E. (2009). Non-medical use of prescription analgesics: a three-year national longitudinal study. Journal of Addictive Diseases, 28, 232-42.
  6. Alam, F., D'Agnone, O., Bremner, D., Tuckey, G., Abbasi, Y., & Littlewood, R. (2017). Towards best practice: trends in the management of opioid analgesic dependence. Heroin Addiction and Related Clinical Problems, 19 (1), 55-62.

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About Professor James Elander

Professor James Elander, Head of Centre for Psychological Research at the University of Derby, has conducted research into the psychological aspects of pain management; particularly in the treatment of painful chronic conditions such as haemophilia, sickle cell disease, and chronic headaches. He has also overseen studies into addiction to over-the-counter painkillers. This includes developing and evaluating interventions to improve people's self-management of pain, and studies of the interpersonal staff-patient dynamics that affect quality of pain management, especially in hospital.He is a member of British Psychological Society (Chartered Psychologist), Health Care Professions Council (Registered Health Psychologist), Higher Education Academy (Registered Practitioner and National Teaching Fellow) and Society for the Study of Addictions. He may be contacted via https://www.derby.ac.uk/staff/james-elander /

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