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They say that if a person is in severe pain, it is impossible for him/her to become addicted to pain medication. If the body is in pain, the pain medication targets the messaging system that tells us we are in pain. We are numbed to it because it helps to block that message. When someone is not in pain, medications for pain can solely target the pleasure centre of the brain instead, which *can* become addicting all on its own.
I do not necessarily believe all of the above is entirely true. I believe that someone who is particularly susceptible to be an addict will always struggle internally with addiction, pain or no pain.
Obviously there is a difference between addiction, tolerance, and dependence.
Addiction includes an irrationality to it, where a person will do whatever it takes to get that feeling again. This includes all types of crime, risk, personal danger, and often a lack of awareness. Addiction controls the mind in the sense of desperation without cause.
Tolerance is the loss of efficacy of a medication due to long-term use. There are many medications (like Synthroid, Ursodiol or Zofran for instance) that you do not build a tolerance to - once you find your proper dose, that should be the correct dose long-term. There are exceptions, of course, but the vast majority of people will be on the same or close to the same dose of certain medications for the rest of their lives. Other medications, like antibiotics and opioids can cause a person to become tolerant. This means that the dose that used to work before now works less efficiently and the dose must be increased to maintain the same level of efficacy. With antibiotics it is a resistance. If your body builds a resistance to antibiotics then you have to avoid that particular medication for infections for a period of time so that the next time you do take it, it will actually get the job done. With long-term use of these kinds of medications, cycling through the different types or progressively increasing the dosage is crucial for maintaining a steady level of long-term care.
Dependence - although very commonly (and incorrectly) used synonymously with addiction - is quite different. Dependence is the body's response to a medication or substance that is required for the body to function normally. If your body has malfunctioned - from injury, illness, genetic mutations, inflammation - and needs a medication for it to do something it should be doing on its own, that is dependence. Due to my autoimmune thyroid condition, I am dependent on my Synthroid. If a person were to take laxatives every single day, that person's digestive system will likely become dependent on that laxative to function normally since it has adapted to that constant stimulus. In MANY cases, like the latter example, a person can be weaned off of that dependence and function normally (like in the case of laxatives or Prednisone), but none of that equates addiction.
It is absolutely miraculous what the body can learn to adapt with. A person who is dependent on pain medication to function normally is not automatically susceptible to addiction. If the driving force of taking a certain medication is pain relief, specifically, then it is a logical seek. If the driving force, however, is the high, the euphoria, and if the person makes illogical, irrational, and dangerous decisions to get that substance - that is addiction.
What IS similar between addiction and dependence is the withdrawal symptoms. Being weaned off of or removed from pain medication will absolutely result in symptoms mimicking withdrawal (as will weaning off of Prednisone and a whole host of other strong medications). Exhaustion, nausea, vomiting, excessive sweating, extra pain and added pain - the body wants and needs that medication. It can also be dangerous if your dosage has already gotten to a certain level. It is a hellish experience.
The difference becomes the motivation behind wanting or needing to take the medication. It is a much different circumstance when a person seeks illicit substances - and will do or say anything to get it, including putting oneself or others in danger to do so - for the euphoric high experience when compared to someone in debilitating pain seeking pain medication to help that person be capable of functioning at a relatively normal level.
The other part of the comparison between addiction and dependence that rings true is the desperation. People in severe pain every single minute of their lives will absolutely exhibit signs of desperation for relief. When the average person contracts a horrible flu or food poisoning or suffers a tooth abscess or needs a root canal, that desperation for relief is there. Imagine that kind of pain 24 hours a day for the rest of your life. It is clear why chronic pain patients can become desperate for relief. The difference is in how far that desperation will take someone. If that desperation completely takes over the ability to make logical and sound decisions, this is where it can cross the line into addiction. When a person's conscience is compromised, when relationships and finances are in utter ruins, and when there is a complete lack of self-awareness, responsibility, rational decision-making, and a chronic history of putting yourself and those around you in peril - to the point where you know for a fact that you and others may likely die just by taking one little pill - THAT is where the problem lies.
Desperation with cause, although not immune to addictive behaviours, is much different than desperation without cause.
Bear in mind the massive spectrum of mental disorders that are poorly understood and poorly managed. Many of these illnesses present with physical symptoms - even though the public cannot see them - and cause a great deal of suffering.
I am not saying that a person in chronic pain cannot become addicted. Anyone can become an addict - to just about anything on the planet - and certain medications and substances possess addictive properties that can encourage those behaviours. What I am saying is that there are very significant differences between tolerance, resistance, addiction, and dependence, and clumping them together is misguided and shows a lack of understanding.