Spinal Cord Injury: Chronic Pain and Risk of Addiction
A common cause of chronic pain is a past traumatic spinal cord injury. This type of injury can be incurred during automobile crashes, construction accidents, or falling off a ladder at home. How to treat this pain effectively was a matter of controversy not long ago, because the most effective prescription analgesics are also addictive.
Chronic pain is that which persists past a reasonable period for healing and can be experienced continuously or sporadically (1). Some injuries may never fully heal and a state of chronic pain can exist indefinitely as a result. This is a common outcome for people who have had a traumatic spinal cord injury resulting in paralysis, hemiplegia, paraplegia, or quadriplegia/tetraplegia. Untreated or under-treated chronic pain can prolong the healing process, add additional stress to a person’s life, have a negative impact on the lives of their loved ones, cause anxiety and psychological impairment, and lead to extended bouts of despondency. Effective pain management is therefore essential to the healing process and improving the patient’s quality of life.
A review of the research literature revealed wide-ranging discrepancies between studies examining the prevalence of chronic pain among patients with traumatic spinal cord injuries, finding rates that ranged between 26 and 92% (2). In addition, no evidence of a gender bias or correlation with the severity of injury was found. Dijkers et al., (2009) concluded that the lack of consistent criteria for determining pain levels, rather than extreme variability among patients, explained their findings (2). The frequency with which chronic pain afflicts patients who have suffered a traumatic spinal cord injury is therefore unknown.
A diagnosis of debilitating chronic pain due to a past spinal injury often places the physician in a difficult position of determining whether to risk prescribing an opioid-based pain reliever. These risks include whether the drug will be effective over an extended period, potential toxicity, exposure to legal sanctions by government regulatory agencies, and patient addiction (3). These fears are not without some factual basis. Between 1997 and 2006, prescriptions for opioid pain relievers increased from 50.7 to 115.3 million grams per year and the number of deaths resulting from opioid analgesic poisonings increased from 4,000 to 13,800 between 1996 and 2006 (4). The physician also faces the difficult task of monitoring the patient for signs of substance abuse. One study found that up to 90% of family physicians failed to notice classic signs of substance abuse and at least half failed to question the patient on this matter (4).
When the prevalence of opioid addiction among chronic pain patients was examined in a recent study, these fears were not supported by the findings (3). In this and other studies mentioned, no evidence supporting an increased risk for developing a substance abuse problem was found in chronic pain patients being treated with opioid analgesics, and a history of substance abuse was not predictive of whether the patient abused opioid pain medications. This finding contrasted with earlier studies, but the authors of the more current study pointed out that patients with insufficient pain relief often engage in drug seeking behavior and previous studies failed to control for this possibility. In addition, the current study found that the effectiveness of the analgesic effect was maintained over a period of years with no evidence of toxicity. The authors explained that the presence of chronic pain seems to protect the patient from developing tolerance to opioid pain medications. Concerns about legal liabilities have been allayed somewhat by the Drug Enforcement Agency announcing in 2006 that physicians should not hesitate to prescribe opioid analgesics if patient assessment dictates their use (4).
Each of these accidents and many others can be caused by someone or something else, with another party completely responsible for the accident. Whether a mechanical defect, equipment malfunction, or any type of safety neglect or abuse, you won’t receive compensation if you don’t go about it the correct way. Many companies or individuals will offer a small settlement, sometimes as much as $500,000, but this is just not going to cover your overall costs endured due to the spinal injury. You may not even receive that much, with many companies seeking the cheapest settlement possible. This may pay for your doctor’s and medical bills, but you will likely be at a loss when it comes to affording the long-term rehabilitation, especially with the many advances that are being made. You may just have to seek out a spinal cord injury lawyer to ensure you are able to receive the compensation necessary to afford the latest advancements in spinal rehabilitation.
The effective management of chronic pain arising from a past spinal cord injury can therefore include opioid-based analgesics without increased concerns about safety or effectiveness. In addition, the risk of addiction appears to be small or non-existent for chronic pain patients. Any concerns about the possibility of the patient developing a substance abuse problem can be addressed through close monitoring strategies, such as regularly scheduled urine drug testing (4). These conclusions contrasts with attitudes prevalent not long ago that viewed opioid analgesics as carrying unacceptably high risks for patients suffering from chronic pain who were not terminally ill. This sea-change had a lot to do with the publication of several definitive research studies over the past decade that revealed pain was being chronically under-treated by physicians.
- Pain Physician (2009), 12:E35-E70
- J Rehab Res Devel (2009), 46(1):13-30
- Arthrit Rheum (2005), 52(1):312-321
- Pain Physician (2010), 13:167-186
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