With 4.7m people in the United States dependent on painkiller medication and numbers in the UK that are lower than those in the US but rising quickly in what has been described as a potential ‘public health disaster’, addiction to prescribed pain relief is a serious and growing problem. James Elander, Head of Psychological Research, discusses new research into painkiller addiction and how to spot the warning signs.
Many people take painkillers to help them live with pain, with some becoming addicted to pain medication. This is a difficult problem which makes their pain even harder to control. Other people are so afraid of addiction they don’t take painkillers and suffer unnecessarily from pain.
It is hard to get the balance right between the benefits of painkillers and the risk of addiction, so a quick way to tell if you are at risk could help people manage their pain better, as well as help the health professionals who work with them.
I, along with a team of researchers at the University of Derby, have carried out some new research into painkiller addiction. Our study identified two key questions that people can ask themselves to find out whether they are at risk of addiction to painkillers. This can help people to know if they are really at risk, or whether they are worrying unnecessarily about addiction to painkillers.
Would you be unwilling to reduce your pain medication?
Do you feel you depend on your pain medication?
If your answer to both those questions is ‘yes, definitely’, you can take steps to reduce your risk of addiction to painkillers. On the other hand, if it is ‘definitely not’, then perhaps you are more concerned about addiction to painkillers than you need to be.
New research into painkiller addiction
Our research used information from 683 people with different types of pain – the most common of which were headaches, back pain, joint pain, muscle pain and period pain.
The painkillers that were the most commonly used by people in the study were strong opiates such as morphine, fentanyl, and tramadol; weaker opiates such as dihydrocodeine and codeine-based compounds such as co-codamol; and nonopiates, mainly nonsteroidal anti-inflammatory drugs such as naproxen, diclofenac, and ibuprofen.
One aim of the study was to find key signs of how likely a person is to get addicted to painkillers. We produced a short questionnaire to measure different aspects of people’s concerns about painkillers, and people’s answers to those two key questions were the best predictors of how addicted or psychologically dependent they were on painkillers.
The research combined data from three studies by myself, Dr Frances Maratos, Reader in Emotion Science, Derby PhD students Omimah Said and Malcolm Schofield and undergraduate Psychology students Ada Dys and Hannah Collins.
The studies were funded by a University Research for Learning and Teaching Fund grant, a British Psychological Society Undergraduate Research Assistantship bursary and a University Undergraduate Research Scholarship Scheme bursary.
In the first study, people completed a pain medication attitudes questionnaire with 47 questions and had their painkiller dependence measured. The links between their answers to each of the 47 questions and their dependence score was then examined to produce a version with just 14 carefully selected questions.
In the other two studies, different groups of people with pain completed the version with just 14 questions. This short version worked as well as the one with 47 questions, and in all three studies those two key questions consistently predicted how dependent on painkillers people were.
These findings build on previous University of Derby research, published in 2014 in the journal Pain Medicine, which showed people were more likely to become dependent on painkillers if they took more prescription painkillers more often, or had a prior history of substance-related problems, or were less accepting of pain.
This showed that there was more than one way to become dependent on painkillers, so people who answer ‘yes’ to the two questions identified in the most recent study might then use these questions to reflect on how the way they use painkillers may be developing into an addiction:
Am I using strong painkillers more often than I used to?
Am I using painkillers a bit like I used to use drugs or alcohol?
Am I getting more sensitive to pain, or having more trouble living with it, than I used to?
We hope to use the findings to develop better information and education for people about painkiller addiction.
For the moment, anyone who is worried about how they use painkillers should talk to their doctor, or pharmacist, or even a friend or family member about how their relationship with painkillers may be changing.
They could also use the information that is already available, including the website of Kathryn Kemp, author of Painkiller Addict – From Wreckage to Redemption.
*The latest research was also featured in an article by Cindy Lampner in Clinical Pain Advisor, an online magazine for pain management specialists and other clinicians.