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?"


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.

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