Nov 9, 2005 By: Maia Szalavitz Huffingtonpost.com

Chronic pain can be treated safely with pain meds

Actor George Clooney recently told the media that he refuses to take opioid painkillers for fear of addiction. Despite an injury that required spinal surgery and left him with daily, blinding headaches, Clooney said, “”I don’t take painkillers because we’ve had members of our family who have become very fond of painkillers over the years.”

But a family history of addiction-or even a personal history of the problem-should not rule out pain treatment with opioids if it is needed. Along with our ongoing “war on drugs,” shows like E.R. and statements like Clooney’s have resulted in an exaggerated perception of accidental addiction associated with pain treatment, and this perception is leading to continued under-treatment of both chronic and end-of-life pain.

In his comments, Clooney specifically noted that his aunt, Rosemary Clooney, who had a history of alcoholism and addiction, apparently became addicted to pain medication before her death from lung cancer three years ago.

But was Rosemary Clooney simply physically dependent on medication needed to ease her cancer pain? Research finds that 80 percent of cancer patients have severe pain in their final months; anyone who takes opioids for long enough will become physically dependent. Dependence is needing a drug to function and avoid withdrawal symptoms-addiction is compulsive use despite negative consequences. It’s hard to imagine that a woman dying of lung cancer would have worse consequences from taking painkillers than from refusing them.

Studies repeatedly find that people taking painkillers as prescribed do not have addiction rates higher than for the general population: Without a history of addiction, the odds of becoming an addict due to doctor-prescribed opioids are roughly 1 percent.

Further, the clinical experience of physicians who treat former addicts for severe pain (so far, there’s little published data on this topic) suggests that opioids can be used safely without relapse into addictive behavior if patient and doctor collaborate diligently.

So even if Clooney has a personal, and not just a family history of addiction, the best available data suggests that he is doing himself little good by avoiding the best medications we have for pain. And he’s certainly not doing other pain patients any favors by spreading fear about the dangers of opioids when they can be used safely.