The Relationship Between Chronic Pain and Substance Abuse

September 3, 2019

The relationship between chronic pain and substance abuse is a complex data set to understand and analyze to gather useful and applicable information to help reduce the number of people struggling with addiction and the number of overdoses in America.

Dr. Mark Ilgen from the Veterans Affairs Center for Clinical Management Research in the Department of Psychiatry at the University of Michigan is one of the researchers currently working on this topic.

During the second endowed lecture of the year at the College of Community Health Sciences, the Alice McLean Stewart Endowed Lecture for Addiction Education, Ilgen discussed the ramifications of treating chronic pain with addictive substances, specifically cannabis and opioids.

To start his lecture, he cleared up some of the misconceptions about pain that have been disproven. Previously, researchers believed pain directly correlated to damage to tissues and the body. However, now doctors and scientists have found that pain is a complex mental as well as physical reaction that has a lot to do with how an individual reacts to catastrophe.

Ilgen said that a literature review found that people who reported chronic pain were more likely to also have a substance abuse disorder. However, the question remains whether the substance abuse disorder existed before the pain or if it came afterward.

In Alabama, Ilgen said there are areas that exceed the national death rate from opioid-related causes. Escambia County for example is more than twice the national average with 31.2 of 100,000 people dying from opioid abuse.

Ilgen said the latest call for action endorses medical marijuana as a replacement for opioids in pain management. However, Ilgen said that this is not a solution but rather another form of the problem. Marijuana is not, as some report, non-addictive, Ilgen said. It just has a lower probability of transitioning to dependence.

A concern when using substances like medical marijuana is getting trapped in a repetitive cycle, Ilgen said. “Are you treating the original symptom or the withdrawal?”

The takeaway, Ilgen said, is to push for policy reform, develop more non-pharmacologic treatments, and gain a better understanding of the complications of treating substance abuse and chronic pain when they co-occur.

The Alice McLean Stewart Endowed Lecture for Addiction Education strives to develop an understanding and spread knowledge of alcoholism and other chemical elements. The endowed lecture series is organized and provided by the College.