Migraine ain't an addiction

Pardon my poor English, but the sentiment is clearly true. I have spent a career working in pain management. When people have chronic pain, the issue of using potentially habit-forming painkillers, like narcotics, comes up pretty often.

By the time patients would get to see a doctor like me at a specialty pain clinic, they'd probably have taken their share of narcotics. Many patients were even referred because doctors would be uncomfortable that the patient was taking too many pain pills. Which leads to the question, "Is this patient addicted?"

Patients, their family, and their doctors often wonder if addiction might be a problem. The good news is that it rarely is—even among people seeming to take too much medication. Often, when people seem to be overusing painkillers, this is because the pills aren't helping and they're hoping just taking more will make a difference—which it usually doesn't. There are a few simple facts about narcotics:

  • Pain pills are intended to cause a mild decrease in disabling pain. While you'd think that taking more pills would make the pain get even lower, this is usually not helpful. More pills usually gives more side effects without more pain relief.
  • Pain pills only work on certain types of pain. Migraine pain and fibromyalgia, for example, are generally not very responsive to narcotics.
  • People with chronic pain usually have lots of symptoms besides pain—like anxiety, poor sleep, etc. It's easy to start taking pain killers to "treat" these other symptoms, which generally doesn't relieve the symptoms and causes inappropriate medication overuse.

People overusing narcotics or other habit-forming medications are usually not addicted—they're often inappropriately using their medications to try to make their pain and symptoms better. The overuser takes more medications to get better. The addict, on the other hand, is not trying to reduce symptoms—they're simply feeding an addiction and continue to take medications even when they see that the medication use is harmful to them. For the overuser, it's all about trying to control symptoms to get better. For the addict, it's just about getting medication.

I've spent a lot of my career talking to patients and their families about the difference between overuse and addiction. The pain doctor treats overuse, while an addiction specialist manages addictions. So when I saw a new article in the journal Headache comparing personalities of headache sufferers who overuse analgesic medication and addiction patients, I was a bit concerned. It should have been no surprise to these authors when they reviewed their results and concluded personality traits of dependency were not the same in medication overusers treating frequent headache and individuals addicted to substances of abuse. Just seeing the title of the article asking about differences in personality traits in medication overusing headache patients and addicts, however, may result in some people incorrectly equating medication overuse or complaining of frequent migraines with addiction or addiction behavior.

Overusing medication to improve your headaches is generally not helpful—but this is not addiction. It's important for both migraine sufferers and their doctors to recognize why medication overuse is occurring, which in most cases is to treat symptoms and not to feed an "addiction."

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