Addiction versus DependenceAccording to the Journal of American Psychiatry, the word "dependence" was introduced in an effort to combat the stigma associated with the word "addiction," differentiating between patients with psychological cravings for a drug and those with isolated physical dependence. Instead of clarifying, however, this distinction has become confusing for patients. The continued interchangeability of the terms in the media compounds the problem.
The New England Journal of Medicine defines physical dependence as a physiological problem, a problem stemming from the body’s organ systems, and addiction as a psychological problem. While physical dependence is the expected outcome of chronic opioid use and involves the acute onset of withdrawal symptoms when they are stopped, those suffering from addiction exhibit an additional psychological craving for the drug. Addiction involves a pattern of behavior, both drug-seeking and drug-abusing, that is not found in those who are simply physically dependent.
Fortunately, opioids are not the only option for pain relief. Additional treatments are available and can be used by themselves or as adjunct therapies to pain medications. Options range from non-opioid analgesics to simple exercises done at home. Used alone or in combination, they give each patient a wide array of options to control their pain.
Non-Opioid Pain Treatment Options
Physical therapy modalities for pain may include ultrasound, paraffin wax, massage therapy, traction and instruction in specific pain-relieving exercises. Patients may be instructed in biofeedback techniques or receive electroanalgesia from TENS, PENS, or CES. Some therapy locations offer aquatic therapy on site, or instruction on water exercises to do at home. Occupational therapists can offer instruction in ergonomics to prevent poor posture and positioning that leads to pain problems.
Many health insurance companies are now covering the cost of acupuncture and chiropractic office visits to treat pain. Herbal remedies and supplements are not generally covered by insurance, but are an alternative treatment option to consider. Vitamin D supplements have recently been used successfully to treat musculoskeletal pain, and aromatherapy and music therapy have proven successful in some patients.
Psychological interventions for pain include hypnosis and behavior modification techniques. Pain associated with depression or anxiety may be eliminated with an antidepressant or anti-anxiety medication; and Lyrica has recently been introduced specifically for fibromyalgia treatment. Medications for pain include the non-opioid analgesics such as tramadol or Tylenol; muscle relaxants such as Flexeril or Skelaxin; and the topical analgesics like capsaicin. There are a wide variety of medications for specific pain conditions such as migraines, postherpetic neuralgia and peripheral neuropathy. For those seeking arthritis pain relief, it may be as simple as choosing the best NSAIDs for their needs.
If surgical treatment is not an option, interventional therapies such as spinal cord stimulator placement or Botox injections might be considered. Local sympathetic blocks have proven effective for chronic regional pain syndromes, and there are a variety of options available depending on the cause and location of the pain.
With the prevalence of hydrocodone addiction, non-opioid pain treatment options provide both patients and physicians with alternatives to consider. However, if pain cannot be managed with such interventions, opioids are still a safe and effective option when managed correctly. Inadequate pain relief will encourage patients to self-medicate, and a doctor-monitored program that includes opioids is preferable to self-medicating patients. Chronic pain management programs allow patients to explore all the alternatives available, including opioids, while remaining under the management of a single physician.