By Ingfei Chen

The Pain Puzzle

It’s a potent problem for long-term survivors and new patients: Can we get better pain control?

By Ingfei Chen

Fear of Addiction
Another major roadblock to pain relief has been a largely misconceived worry among both patients and doctors that use of opioids—which are federally regulated narcotics—can be a recipe for addiction. Taking these drugs does result in a physiological dependence on them: Abruptly stopping the meds can trigger flulike withdrawal symptoms. But experts say that is not the same thing as self-destructive psychological addiction, in which someone compulsively craves a drug’s euphoric high and will do anything, including breaking the law, to get a supply of the pills.

Confusion over the addiction issue has mushroomed in recent years because of “the OxyContin debacle,” says nursing researcher Judith Paice, the president of the American Pain Society and director of the cancer pain program at Northwestern University’s Feinberg School of Medicine in Chicago. In the mid-1990s, as part of a public campaign advocating proper pain treatment, Paice and other pain specialists had repeatedly emphasized that the risk of opioid addiction was extremely low—far less than 1 percent—based on a single observational study, published in 1980, of almost 12,000 hospitalized patients who had taken at least one dose of opioids.

But with the widening use of opioids to relieve chronic pain conditions beyond those associated with cancer, clinicians noticed that addiction was more of a problem than they had expected among a certain group of people—those who had previously abused alcohol and recreational drugs. And after the U.S. Food and Drug Administration approved OxyContin, the first sustained-release form of oxycodone (the active ingredient in Percocet), drug enforcement authorities began seeing a wave of illegal distribution and abuse of the drug.

According to Paice, the ensuing media coverage was sensationalized. When Rush Limbaugh, the conservative talk-radio host, announced in 2003 that he was hooked on OxyContin, she recalls, “I had five new patients the next day and every single one of them said, ‘Please don’t give me that drug.’ ”

Today, pain specialists recognize that they must carefully screen patients for past troubles with substance abuse. But if a cancer patient doesn’t have such a history, psychological addiction has a low likelihood of happening, says Paice.