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July 9th, 2009
06:00 AM ET

What pain relief options does a recovering addict have?

As a regular feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta:

From Jolene: 
"I have a friend who needs to have his wisdom teeth pulled and will need pain medication. The problem is, he is a recovering addict. Any suggestions?"

Answer:

Jolene, first of all, congratulations to your friend for making it to and staying in recovery. More than 23 million Americans struggle with substance abuse problems every day, according to a recent government survey, but only about 4 million of them actually receive some kind of treatment for their addiction to alcohol or illicit drugs.

That being said, it’s true that since he’s a recovering addict, your friend faces a greater challenge than many when it comes to any type of surgical procedure that’s going to require pain management.

But his pain definitely needs to be treated, regardless. The reason: Studies have shown that if a patient does not receive adequate pain treatment in surgical recovery, his tissues don’t tend to heal as well. Pain that goes untreated can also lead to what pain experts refer to as “wind-up,” meaning the spinal cord gets so bombarded with continuous pain signals that it can lead to a longer, more chronic pain situation. So it’s important to “quiet” the spinal cord by bringing the pain under control.

While the vast majority of patients who undergo oral surgery do take some type of narcotic drug afterward for relief, some people are able to successfully treat their pain with anti-inflammatory drugs such as prescription-strength ibuprofen. These non-habit-forming drugs might be the first step for your friend to try. He will need to discuss this option with his doctor, because there is a greater concern about bleeding with this class of drugs, although usually they are safe especially if taken only for a few days.

If the anti-inflammatory drugs don’t work, however, there are some narcotic drugs that are thought to be less addictive than others. Tramadol is one option. It’s a chemical that works as an antidepressant but also has a weak effect on your brain’s opiate receptors, meaning it can provide pain relief but it doesn’t work as assertively on the brain’s reward system (which can lead to addiction). It’s thought to be safer for people who struggle with addiction. Your friend will need to work with his physician to weigh the risks and benefits of trying a narcotic drug before going down this path.

The critical part of keeping a recovering addict from falling back into a cycle of substance abuse with painkillers is making sure that both the doctor and patient vigilantly monitor the course of pain management. For a procedure like wisdom teeth removal, a patient should start feeling better after a few days, maybe a week max. The doctor should follow up with the patient so that if he still complains of pain, the doctor can re-evaluate what could be causing the pain to continue.


soundoff (15 Responses)
  1. David Fernandez

    Dr. Gupta,
    Congatulations on your 40th birthday!

    I recently celebrated my 53rd birthday and with diet and continued excercise remain fit and in good health. I have been a cyclist since 1991 when I was diagnosed with HIV, and I believe that regular exercise combined with great medical care from doctors in Boston, Miami and Los Angeles, where I have lived have contribued to my well being.

    I've found that being informed and pro-active is indeed the best medicine!
    Thank you for the continuing great advice on improving and maintaining good health.

    Dave F.
    Long Beach, CA

    July 9, 2009 at 09:12 | Report abuse | Reply
  2. Paul Kramm M.D.

    When prolotherapy is often curative for many pain problems, why isn't there more discussions in the press about this amazing treatment that uses the body's own immune repair mechanisms?

    July 9, 2009 at 13:56 | Report abuse | Reply
  3. phil carter

    with the fda attention now focused on narcotic /tylenol medications ,and long overdue ,i feel that it is time perhaps the fda take narcotic pain reliver reserch to the next level ,ie. the synthetic structure of hydrocodone is effective in treating chronic pain,however the addiction tendencies in this formula provide a great risk to the patient becoming dependent on the medication with moderate to long term use ,as well as the paitent developing tolerence to the medication,thus requiring the paitent to consume higher dosage to maintain a involentary physical dependence,when this vicious cycle occurs recovery seems to be elusive,it is of upmost importance that when drug manufactures develope such medication ,the addicttion tendences of the medication must also be reserched and evaluated prior to fda approving the medication,a fourmula effective in treating chronic pain however with physical dependence probable it seem as though the paitent is trading one for the other .

    July 11, 2009 at 11:52 | Report abuse | Reply
  4. Bills Cat

    Jolene,

    I've been sober quite a while now and also had lots of dental work done in that time. Good of you to jump in there for 'your friend' but understand that it's HIS recovery - he's the one has to be upfront with the dentist and doctor instead of quietly taking a script for a few perks "just in case" he needs 'em later. Yeah, he can always call back the dentist if that's REALLY the case, but it's unlikely. That 'just in case' is too tough on the mind of an addict, the prescription starts to out-talk our common sense... 8-) And you being around for moral support can certainly help him do just that. I've had teeth out with barely a need for anything afterward, tends to depend on how much of a struggle is involved - more yanking and pulling = more soreness afterward. Tylenol really do work, so do ibuprofen and naproxen, and silly as it sounds a ice cube right on the sore spot for the first few hours can really calm things down, too. Tell him for me,,,

    Meeting maker make it!
    There's no gram like the program!
    NA or Amen!

    July 23, 2009 at 22:11 | Report abuse | Reply
  5. Sally Booth M.D.

    Dear Dr Gupta:

    I am a Mayo Clinic trained physician practicing in the Indianapolis area. I watched your Housecall program today. I take issue with the implication that the reason the African American Reverand's wife did not get diagonsed with ovarian cancer until it was too late because of the color of her skin.

    I worked on the development of a rapid screening test for ovarian cancer at a Biotechnology firm. I was a member of a group called Ovarcoming Together whose mission was to educate women about the warning signs and symptoms of ovarian cancer because of the fact that they can be vague and discounted by their physicians. I know plenty of well to do white women in this area who experienced the same thing as his wife. Look at what happened to Gilda Rander – her symptoms were discounted as is outlined in her book. I have a good friend (white) who had that happen and she died within 6 months of the diagnosis when it was finally made. What Ovarcoming Together educates women to do is seek and demand a consultation with a Gynecological Oncologist if they are not satisfied that their symptoms are being taken seriously. But I fear that a consultation with a Gynecological Oncologist is exactly the kind of services that no one will get under the reforms being proposed by the current administration. You might want to review one of the cases that Hannity brought forth where a women was told she had no hope and had 6 months to live and went to MD Anderson on her own with her advanced cervical cancer and is now alive 8 years later.

    To imply that she didn't get diagnosed with ovarian cancer simply because she is black is disingenuous and very bad reporting which misrepresents the facts.

    Respectfully,

    Sally Booth M.D.

    July 26, 2009 at 08:01 | Report abuse | Reply
  6. MS RIDDICK

    My fiancee is a recovering addict who has fallen somewhat back to old habits, he is asking me for help and I am willing to help as much as I can but his question is, though he knows he's responsible for his own recovery , I still render to him the support, prayers and help that he needs but what does he do when no ones watching? Need help right away.

    July 28, 2009 at 14:13 | Report abuse | Reply
  7. steve allard

    Dr Gupta I watch you and cnn all the time and I'm very impressed. My best friend Cathy has trigeminal neuralgia. She had a pad installed in her head by Dr kassam in pittsburgh pa about ten years ago. She moved to mass. and started having more problems and ended up with Dr Eskander at mass general, She is now having problems with the batteries and is thinking of putting a new battery and pad in witch would mean an other operation.She has tried pain meds that have caused many problems side effects and addiction. She doesn't know witch doctor to go to and is in a great deal of pain. She is a wonderful person and I wish I could help her. I know I'm asking alot but I hope you can give me some guidance. Thanks Steve.

    July 31, 2009 at 13:42 | Report abuse | Reply
  8. Mercy

    Dear Dr. Gupta:

    I watched your program on addiction. You asked a man "what does addiction feel like?" I wanted to give a better answer and suggest some form of research.

    Addiction affects a person the same way water does. The same impulse that comes when we are dying of thirst. Picture the proverbial cowboy lying in the sand, the sun beating down and scorpions crawling by while he drags himself to the river and you aren't sure he will make it.

    Just as he starts to take his sip of water, if you were to say, " if you don't take that sip of water there will be world peace forever and ever, he would say, let me take a sip and think about it. He is not in a state to make competent decisions.

    Perhaps, if doctors could find a way to humanely research how to stop the urge to drink water when a person is dying of thirst, then that could stop the addiction cycle.

    I hope some kind of magic is found because addiction ruins everything.

    Truly,

    Mercy

    August 1, 2009 at 00:25 | Report abuse | Reply
  9. Concerned

    Dear Dr. Gupta,

    I have a friend who is a drug and alcohol addict in recovery, however he has relapsed a few times recently and has been struggling to get back on track with his sobriety. In addition to this at different times he hurt both his back (pulled muscle) and then later his shoulder (partially separated). His Dr is aware that he is in recovery and some of the drugs his Dr. has prescribed are Valium, Darvocet and Percocet. In addition to these at the same time he has taken 2 different anti depressants – Wellbutrin and Effexor. He claims that there is nothing to worry about in regard to his taking these medications for pain, but I am greatly concerned. Do you have any advice or suggestions?

    August 11, 2009 at 14:38 | Report abuse | Reply
  10. Omar

    Tramadol is quite habit forming. Better options is toradol, if the doctor is ok with that (kidney issues, GI issues can pose problems). Often people will do quite well with Marcaine local anesthetic, and if there is a problem, returning for a second marcaine anesthetic injection. Unfortunately, tramadol is quite reinforcing for addicts.

    August 18, 2009 at 16:31 | Report abuse | Reply
  11. Darla Weaver

    I didnt see Dr. Gupta, on CNN, I have a question, I am a recovering accidental addict. I say accidental because I have had 5 back surgeries, with the last one they put the metal rods and screws in. I have had neck surgery, to repair a disc and they actually put coral reef in my neck to stablize it, i had surgery for vascular necrosis on my right knee, cartlidge repair on my left knee, I have been dx with fibromyalgia, osteoarthritis, DDD, DJD, 1st stage of kidney disease. I have pain everyday 24-7, I have even wrote to Dr. Phil to see if he could help me. I dont want to take narcotics, but i cant live like this the rest of my life either!!! Is there anything I can do? I cant exercise, too painful!!! Am I gonna half to live in pain the rest of my life?? Can you help me??

    April 16, 2010 at 17:24 | Report abuse | Reply
  12. Black Mold

    I’ve been visiting your weblog for a though now and I normally find a gem within your new posts. Thanks for sharing.

    November 2, 2011 at 20:24 | Report abuse | Reply
  13. Eddie

    Thanks for the article. It was very informational and something I, as a recovering addict, would have liked to have read before getting my wisdom teeth pulled. Luckily, I did not encounter any problems when dealing with the win resulting from the surgical procedure. But, I did have many questions in my head when it came to this subject. I hope people who are looking find this article. I ended getting sober at 17 with the help of a sober living called New Life House. Look at their website if you are in need of help! http://www.newlifehouse.com

    July 19, 2012 at 17:55 | Report abuse | Reply
  14. Eddie

    http://www.newlifehouse.com a structured sober living for teens recovering from drug and/or alcohol addiction

    July 19, 2012 at 17:57 | Report abuse | Reply
  15. peter

    I'm finding them for my sister. I'm trying to find the most recipes with pictures and the ages of baby for the recipes. Blogs are usually where I would expect to find them..

    May 5, 2014 at 12:48 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.