You Ask, They Answer: Opioid Addiction

Q: According to the Pain Association of Singapore, one in 10 people suffers from chronic pain and has a 10 percent risk of becoming addicted to painkillers. Can you explain when this happens?

A: Based on a survey by the Pain Association of Singapore, 8.7 percent of our population suffers from chronic pain, with the most common conditions being arthritis and musculoskeletal pain involving the lower back, hips and knees. The risk of becoming addicted to painkillers is greater when these patients are given strong painkillers, such as opioids (also known as narcotic painkillers).

Q: What is the best practice to avoid so that patients on painkillers don’t become addicted to the medications?

A: Prior to prescribing highly addictive opioid painkillers to patients, doctors should properly screen their patients to determine if they are suitable. For example, patients with personality disorders, depression, anxiety or a history of alcohol or drug abuse are at high risk of opioid addiction. The doctor should also have a treatment plan in  place for a patient who is about to start painkillers, especially high addictive ones such as opioids, and then regularly monitor the patient for compliance to therapy. Opioids should be discontinued if the patient shows aberrant drug behaviour or if the patient does not derive any pain relief from escalating doses of opioids.

Q: A commentary published in The New England Journal of Medicine stated that focusing on reducing the intensity of pain can lead to escalating the doses of painkillers, thus patients are recommended to focus on their emotional reactions to pain with ‘coping and acceptance strategies’ instead. Could you share your thoughts on this statement? Do you believe doctors overprescribe painkillers?

A: Yes, I agree. Psychological interventions through coping strategies or acceptance commitment therapy have been shown to help chronic pain patients. Thus, such methods will definitely reduce patients’ reliance on painkillers. I also believe that some doctors overprescribe painkillers. This may stem from a poor understanding of the underlying cause of pain, lack of education on the use of addictive painkillers and the desire to take the easy way out by simply dispensing painkillers to patients instead of treating them holistically and gradually.

Q: Are there any alternative pain management therapies that can replace or complement painkillers?

A: Yes, there are alternative pain management therapies. Some conservative methods include psychotherapy, traditional Chinese medicine, physiotherapy and exercises. There are also minimally invasive interventional pain therapies that many pain clinics offer. Some of these treatments include joint injections, epidural steroid injections, radiofrequency ablation of spinal nerves as well as spinal cord neurostimulation.

Dr Ho Kok Yuen
Pain Specialist, The Pain Clinic, Mt. Alvernia Medical Centre, Singapore
thepainclinic.com.sg

This story was originally published in 2017 October issue of Global Health and Travel magazine