Pain ‘KILLER’ Addiction

In every household the medical kit will have painkillers such as paracetamol, ibuprofen, aspirin, Tylenol and the like and these are taken when the individual feels pain in the body. These painkillers also called analgesics are part of a group of drugs used to interfere with the nervous system’s transmission of the nerve signals which we perceive as pain and cause relief from the pain. These painkillers act in various ways on the Peripheral Nervous System (PNS) and Central Nervous System (CNS).

Most of the painkillers stimulate portions of the brain associated with the pleasure, nucleus encumbers. There will be release of neurotransmitters like dopamine which is associated with the stimulation of feeling good. And in addition to the blocking of the pain they are ;also produce the feeling of ‘high’ to the individual taking it. 

Three main types of painkillers:

1. Non-steroidal anti-inflammatory drugs (NSAIDS): These drugs are the most common pain relief drugs used around the world. NSAIDS are members of a drug class that reduces pain, decreases fever, prevents blood clots and when taken in higher dosages it decreases inflammation. 
2. Paracetamol : It is also known as acetaminophen. It is used as a medication to treat pain and fever. It is used for mild to moderate pain relief. 
3. Opioids :  these opioids also interchangeably used with opiates are derivatives synthetically and naturally from opium poppy plant respectively. These opioids are divided into weak and strong opioids. 

Weak opioids commonly consist of Codeine and Dihydrocodeine. They are extremely effective analgesics often used to treat severe pain. These set opioids can lead to significant addiction and adverse effects so when taken and given individual have to be cautious and should not be underestimated. 

Strong Opioids commonly consist of Morphine, Oxycodone, Pethidine and Tramadol. The extreme usage of these opioids are prescribed painkillers for pain relief of surgeries and treatments. These opioids usage over a period of time will lead the individual to have addiction and adverse side effects of abuse and overdoses. 

How do these painkillers work?

Painkillers interfere with pain messages sent to the brain via nerve endings, which will affect the brain, spinal cord or the injured area. 

NSAIDs work by blocking (inhibiting) the creation of prostaglandins by special enzymes Cox-1 and Cox-2. Paracetamol – there are no researches or any biological formula for the working of the paracetamol. But it is also known that it works by blocking (inhibiting)  COX enzymes in the brain and CNS. Paracetamol does not treat inflammation. Opioids work by binding to certain receptors (opioid receptors) in the CNS and body. This effect leads to reduction of pain. This also increases the individual’s tolerance for pain.

Side Effects of Opioid Administration:

Side effects include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent proper prescribing and in turn inadequate pain management. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus.

It is known that continuous, vigorous usage of the opioids will lead to addiction.

Addiction

Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm. Amenance for long term usage of opioids without prescription / opioid therapy is addiction. It is usually defined as the development of abuse or dependence. This kind of addiction is poles apart from misuse of drugs/ substance/ opioids. 

What is Abuse? This describes people who don’t have the same compulsion or physical need to use a substance as those with dependence, but who use it on a regular basis. As a result, they may fail to fulfill major responsibilities, continue using the substance even though it imperils relationships, or incur other types of problems.

What is Dependence?  

‘opioid dependence develops after a period of regular use of opioids, with the time required varying according to the quantity, frequency and route of administration, as well as factors of individual vulnerability and the context in which drug use occurs. Opioid dependence is not just a heavy use of the drug but a complex health connotation that has social, psychological and biological determinants and consequences, including changes in the brain. It is not a weakness of character or will.’ – World Health Organisation , 2006.

Painkiller addiction: The release / production of neurotransmitters like endorphins caused by opiate(natural) or opioid (fully or partially synthetic) use leads to feelings of relaxation and calmness, feeling good  which can be highly addicting. 

Symptoms:

Physical Symptoms:

1. Constipation, nausea and vomiting
2. Pinpoint pupils, sedation
3. Slurred speech
4. Itchy, flushed skin
5. Respiratory depression, increased risk of cardiovascular complications
6. Seizures, tolerance

Psychological symptoms:

1. Depression
2. Anxiety
3. Worsening mood states
4. Psychosis (over a period of time)
5. Suicidal thoughts or idealization 

Mood, behavioral symptoms:

1. Mood swings
2. Euphoria
3. Constant lying
4. Social isolation
5. Stealing to obtain more painkillers and visiting multiple doctors

For the time being when an individual is taking the substance he/she has to increase the number and amount of doses in order to get the same effects of feeling good, feeling relaxed as experienced the last time taken. This increasing the amount and substance (opioids)  is done when the individual has attained tolerance to the substance(opioids) for the previous used amount of intake.

So the frequent increase of the substance due to tolerance to the amount of substance (opioids) will make the individual develop physiological dependence. That means every time the person attains tolerance to the substance (opioids) that means body and brain have adjusted to the amount and the presence of the substance (opioids)  so much that it starts to produce a feeling of normal. When an individual who is dependent on substance (opioids)  or drugs stops the intake they will be experiencing withdrawal symptoms. 

Tolerance, dependence, and addiction can co occur independently or simultaneously. With all three, there is a risk of experiencing withdrawal symptoms when opioid use is stopped. Withdrawal symptoms may include the following:

Agitation, Anxiety, Fever, Insomnia, Sweating, Muscle aches and pains, Abdominal cramping, Diarrhea, Nausea, Vomiting

These opioid painkiller withdrawal symptoms are uncomfortable but not life threatening.

1. Opiate Abuse : Opiates produce euphoric and tranquil effects when taken in amounts that are larger than prescribed. The pleasant, care-free feelings a person experiences when taking these drugs are often what leads to destructive patterns of abuse. Opiate addiction is often characterized by compulsive drug-seeking behavior. 

1. Opioid Overdose: An overdose is commonly caused by taking too much of a substance (opioids)  at any given time or by combining multiple substances, especially other central nervous system depressants such as benzodiazepines and alcohol. 

Treatments 

According to Principles of Drug Addiction Treatment; A Research-Based guide  NIH Publication, 2012,(3rd ed.),  Addiction requires individualized treatments that address the symptoms and underlying causes of the disease, as well as the consequences that substance use has on different areas of a person’s life. This includes their ability to socialize, their physical and mental health, and consequences at work, home, school, or with the law. 

The following are some of the addiction treatments

1. CBT –  Cognitive Behavioral Therapy : CBT can be applied in the treatment of many different types of problematic substance use.
2. CM – Contingency Management : This method provides material rewards as motivation for desirable behaviors, such as maintaining sobriety.
3. MI – Motivational Interviewing : This method of resolving ambivalence in recovering individuals to allow them to embrace their treatment efforts to best change their problematic substance use behavior. 
4. DBT – Dialectical Behavioural Therapy : It can be adapted for many substance abuse cases, but mainly focuses on treating severe personality disorders, such as borderline personality disorder.
5. 12 Step Facilitation : 12-Step facilitation therapy aims to promote continued abstinence by engaging people in recovery with 12-Step peer support groups.
6. Matrix Model : It employs a combination of various therapeutic techniques and was originally developed for the treatment of individuals with stimulant addictions.

Painkiller addiction is not something which should be underestimated. This opioid addiction is killing more number of people than people dying with intake of heroin and cocaine. The mental well being of the individual is at stake along with individuals around them. This addiction is also characterized by compulsive drug-seeking behavior and also individuals’ thinking pattern is always deviated. There will be lack of judgement and also poor decision making caused due to this. The continuous intake of drugs and increase in tolerance of the intake will cause sometimes overdoses which will harm the mental well being and emotional well being of the individual. This painkiller is a killer of not only pain but also sustaining self and the trap fallen is the addiction.