<blockquote>
  <p>I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain. </p>
</blockquote>

<p>Yes. However:</p>

<p>You need to be careful about your use of the word pain: opioids are analgesics, they relieve the subjective experience of pain. They're addictive. </p>

<p>Lignocaine is a local anaesthetic: it prevents <em>nociception</em> or the sensory input that indicates the presence of a noxious stimulus. This in turn renders the relief of any pain unnecessary.</p>

<p>More broadly, however, I was going to suggest that people can become addicted to unpleasant things, not because the unpleasant this is pleasant per se, but because the removal of said unpleasantness is relieving.</p>

<p>A little tangential, but may be worth a read: <a href="https://doi.org/10.1016/j.pnpbp.2005.10.011" rel="nofollow noreferrer">Are nonpharmacological induced rewards related to anhedonia? A study among skydivers</a></p>

<blockquote>
  <p>While we often hear about opioid addiction, which is primarily physical, </p>
</blockquote>

<p>This is where you've lost me. While opioid dependency is definitely characterised by physical features e.g. withdrawal syndrome, I think it's very inaccurate to consider it purely a "physical" dependency. If this were the case, then following a prolonged period of abstinence, there would be no concern of relapse -- the once dependent individual has no "physical addiction" to opioids to speak of.</p>

<p>If you would like to know the difference between "physical" dependency to opioids and "physical and psychological" dependency to opioids, I would suggest the following treatment schedule:</p>

<ol>
<li>Take the OTC medication loperamide, which is an opioid agonist that cannot cross the BBB. </li>
<li><p>1 week washout</p></li>
<li><p>Take heroin every 8 hours for two weeks</p></li>
<li><p>1 week washout</p></li>
<li><p>Report back if you noticed a difference between heroin and loperamide.</p></li>
</ol>

<blockquote>
  <p>I wonder if someone could psychologically be hooked on using something like Lidocaine to numb every bruise or injury they get just to numb the pain.</p>
</blockquote>

<p>Yes, but not for the reasons you are thinking. </p>

<p>Local anaesthetics act locally, and are the functional equivalent of a reversible lesion to the nerves they are acting on. Anything that an individual finds pleasant can become "addicting", but with respect to lignocaine, it's prudent to note that if it were addictive, it would have nothing to do with any action centrally.</p>

<blockquote>
  <p>I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting. </p>
</blockquote>

<p>Cocaine is still used in ENT surgery, as it is an highly effective vasoconstricting agent. </p>

<p>Its addictive properties, however, are largely thought to be limited to the "psychological" space. Yes, I state that in full appreciation for the above regarding physical. This is not to say that an individual does not have "physical symptoms" e.g. tiredness, but that these symptoms have a locus somewhere in the brain.</p>

<blockquote>
  <p>This makes me wonder if physical withdrawal and hunger cravings are similar.</p>
</blockquote>

<p>One concept in neuroscience/neuropsychology is the <em>somatic marker hypothesis</em> by Dimasio, which proposes that our behaviours/decisions are effectively guided by somatic, or physical sensations that are strongly linked to our emotions. </p>

<p>Thus, the body's need for food would instantiate a physiological state of discomfort that drives us behaviourally to seek food. </p>

<p>Likewise, the body's need for more IV heroin, would evince its own set of "somatic markers" likely to guide one's own behaviour towards the acquisition of more intravenous heroin. </p>

<p>See below:</p>

<blockquote>
  <p><a href="https://doi.org/10.1016/j.geb.2004.06.010" rel="nofollow noreferrer">The somatic marker hypothesis: A neural theory of economic decision</a></p>
  
  <p>Modern economic theory ignores the influence of emotions on
  decision-making. Emerging neuroscience evidence suggests that sound
  and rational decision making, in fact, depends on prior accurate
  emotional processing. The somatic marker hypothesis provides a
  systems-level neuroanatomical and cognitive framework for
  decision-making and its influence by emotion. The key idea of this
  hypothesis is that decision-making is a process that is influenced by
  marker signals that arise in bioregulatory processes, including those
  that express themselves in emotions and feelings. This influence can
  occur at multiple levels of operation, some of which occur
  consciously, and some of which occur non-consciously. Here we review
  studies that confirm various predictions from the hypothesis, and
  propose a neural model for economic decision, in which emotions are a
  major factor in the interaction between environmental conditions and
  human decision processes, with these emotional systems providing
  valuable implicit or explicit knowledge for making fast and
  advantageous decisions.</p>
</blockquote>

CC BY-SA 3.0
2018-02-22T10:19:04.627Z
2018-02-22T10:49:22.717Z
2018-02-22T10:49:22.717Z
faustus
<p><strong>Short answer</strong><br>
Basing an answer strictly on the DSM-V criteria, local anesthetics <em>may</em>, purely hypothetically, be associated with a mild form of addiction. But realistically, I think it is unlikely that a person (ab)using a topical anesthetic will ever be medically diagnosed as having a substance abuse disorder.  </p>

<p><strong>Background</strong><br>
I think the question hinges on the definition of [drug] <strong><a href="https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction" rel="nofollow noreferrer">addiction</a></strong>. The APA addresses <strong><a href="https://www.buppractice.com/node/12351" rel="nofollow noreferrer">addiction in DSM-V</a></strong> by the following criteria (entered in shortened form for brevity):</p>

<blockquote>
  <p>A minimum of 2-3 criteria is required for a <strong>mild substance use
  disorder</strong> diagnosis, while 4-5 is moderate, and 6-7 is severe [...]</p>
  
  <ol>
  <li>Taking the opioid in larger amounts and for longer than intended</li>
  <li>Wanting to cut down or quit but not being able to do it</li>
  <li>Spending a lot of time obtaining the opioid</li>
  <li>Craving or a strong desire to use opioids</li>
  <li>Repeatedly unable to carry out major obligations at work, school, or home [...]</li>
  <li>Continued use despite [...] social or interpersonal problems [...]</li>
  <li>Stopping or reducing important social, occupational, or recreational activities [...]</li>
  <li>Recurrent use of opioids in physically hazardous situations</li>
  <li>Consistent use of opioids despite [...] physical or psychological difficulties [...]</li>
  <li>[Development of t]olerance [...]</li>
  <li>[Development of w]ithdrawal [symptoms]</li>
  </ol>
</blockquote>

<p>In contrast to opiates, <a href="https://clinicaltrials.gov/ct2/show/NCT01929343" rel="nofollow noreferrer"><strong>lidocaine has no rewarding or addictive properties</strong></a>. As a result, lidocaine can be used systemically and on a long-term basis for the treatment of chronic pain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561441/" rel="nofollow noreferrer">(Yousefshahi <em>et al</em>., 2017)</a>. In fact, lidocaine, has equally effective anelgesic effects in people addicted to opioids as in normal controls <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231267/" rel="nofollow noreferrer">(Hashemian <em>et al</em>., 2013)</a>. Because lidocaine is a local anesthetic without central effects, and taken together with above findings, we can safely rule out the occurrence all of the criteria except, perhaps, the first three. Those first three may be, at least hypothetically, possible when topical or systemic application relieves some sort of untolerable pain. Given that meeting 3 criteria meets the definition of a mild substance abuse disorder (mild addiction), I wouldn't rule addiction to topical anesthetics out completely. It does seem unlikely, though.  </p>

<p>Cocaine has strong addicitve effects, because of it's pronounced effects in the central nervous system - it is associated with strong feelings of reward and euphoria. It rapidly induces tolerance as well as dependence; a school book example of a substance of abuse. Lidocaine is a cocaine derivative that still exhibits its anelgesic properties, without its psychoactive component <a href="https://www.ncbi.nlm.nih.gov/pubmed/20001286" rel="nofollow noreferrer">(Small, 2009)</a>.    </p>

<p><sub><strong>References</strong><br>
<strong>-</strong> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231267/" rel="nofollow noreferrer">Hashemian <em>et al</em>., <em>J Emerg Trauma Shock</em> (2014); <strong>7</strong>(4): 301–4</a><br>
<strong>-</strong> <a href="https://www.ncbi.nlm.nih.gov/pubmed/20001286" rel="nofollow noreferrer">Small, <em>Subst Use Misuse</em> (2009); <strong>44</strong>(13): 1888-98</a><br>
<strong>-</strong> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561441/" rel="nofollow noreferrer">Yousefshahi <em>et al</em>., <em>Anesth Pain Med</em> (2017); <strong>7</strong>(3): e44732</a></sub></p>

CC BY-SA 3.0
2018-02-22T10:30:31.933Z
2018-02-22T12:38:49.833Z
2018-02-22T12:38:49.833Z
AliceD
<p>I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain. While we often hear about opioid addiction, which is primarily physical, I wonder if someone could psychologically be hooked on using something like lidocaine to numb every bruise or injury they get, just to numb the pain.</p>

<p>I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting.
This makes me wonder if physical withdrawal and hunger cravings are similar.</p>

<neuroscience><behaviorism><psychopharmacology><addiction>
Can you get addicted from using topical or local anaesthetics to ease pain?
The Harmonic Rainbow
# Can you get addicted from using topical or local anaesthetics to ease pain?

(Asked by: username_0 on 2018-02-21)

I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain. While we often hear about opioid addiction, which is primarily physical, I wonder if someone could psychologically be hooked on using something like lidocaine to numb every bruise or injury they get, just to numb the pain.

I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting.
This makes me wonder if physical withdrawal and hunger cravings are similar.

**Tags:** neuroscience, behaviorism, psychopharmacology, addiction


---

## 2 answers

### Answer by username_2 on 2018-02-22. Score: 2 | Accepted answer

**Short answer**  
Basing an answer strictly on the DSM-V criteria, local anesthetics *may*, purely hypothetically, be associated with a mild form of addiction. But realistically, I think it is unlikely that a person (ab)using a topical anesthetic will ever be medically diagnosed as having a substance abuse disorder.

**Background**  
I think the question hinges on the definition of [drug] **[addiction](https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction)**. The APA addresses **[addiction in DSM-V](https://www.buppractice.com/node/12351)** by the following criteria (entered in shortened form for brevity):

> A minimum of 2-3 criteria is required for a **mild substance use
> disorder** diagnosis, while 4-5 is moderate, and 6-7 is severe [...]
>
> 1. Taking the opioid in larger amounts and for longer than intended
> 2. Wanting to cut down or quit but not being able to do it
> 3. Spending a lot of time obtaining the opioid
> 4. Craving or a strong desire to use opioids
> 5. Repeatedly unable to carry out major obligations at work, school, or home [...]
> 6. Continued use despite [...] social or interpersonal problems [...]
> 7. Stopping or reducing important social, occupational, or recreational activities [...]
> 8. Recurrent use of opioids in physically hazardous situations
> 9. Consistent use of opioids despite [...] physical or psychological difficulties [...]
> 10. [Development of t]olerance [...]
> 11. [Development of w]ithdrawal [symptoms]

In contrast to opiates, [**lidocaine has no rewarding or addictive properties**](https://clinicaltrials.gov/ct2/show/NCT01929343). As a result, lidocaine can be used systemically and on a long-term basis for the treatment of chronic pain [(Yousefshahi *et al*., 2017)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561441/). In fact, lidocaine, has equally effective anelgesic effects in people addicted to opioids as in normal controls [(Hashemian *et al*., 2013)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231267/). Because lidocaine is a local anesthetic without central effects, and taken together with above findings, we can safely rule out the occurrence all of the criteria except, perhaps, the first three. Those first three may be, at least hypothetically, possible when topical or systemic application relieves some sort of untolerable pain. Given that meeting 3 criteria meets the definition of a mild substance abuse disorder (mild addiction), I wouldn't rule addiction to topical anesthetics out completely. It does seem unlikely, though.

Cocaine has strong addicitve effects, because of it's pronounced effects in the central nervous system - it is associated with strong feelings of reward and euphoria. It rapidly induces tolerance as well as dependence; a school book example of a substance of abuse. Lidocaine is a cocaine derivative that still exhibits its anelgesic properties, without its psychoactive component [(Small, 2009)](https://www.ncbi.nlm.nih.gov/pubmed/20001286).

**References**  
**-** [Hashemian *et al*., *J Emerg Trauma Shock* (2014); **7**(4): 301–4](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231267/)  
**-** [Small, *Subst Use Misuse* (2009); **44**(13): 1888-98](https://www.ncbi.nlm.nih.gov/pubmed/20001286)  
**-** [Yousefshahi *et al*., *Anesth Pain Med* (2017); **7**(3): e44732](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561441/)


---

### Answer by username_1 on 2018-02-22. Score: 1

> I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain.

Yes. However:

You need to be careful about your use of the word pain: opioids are analgesics, they relieve the subjective experience of pain. They're addictive.

Lignocaine is a local anaesthetic: it prevents *nociception* or the sensory input that indicates the presence of a noxious stimulus. This in turn renders the relief of any pain unnecessary.

More broadly, however, I was going to suggest that people can become addicted to unpleasant things, not because the unpleasant this is pleasant per se, but because the removal of said unpleasantness is relieving.

A little tangential, but may be worth a read: [Are nonpharmacological induced rewards related to anhedonia? A study among skydivers](https://doi.org/10.1016/j.pnpbp.2005.10.011)

> While we often hear about opioid addiction, which is primarily physical,

This is where you've lost me. While opioid dependency is definitely characterised by physical features e.g. withdrawal syndrome, I think it's very inaccurate to consider it purely a "physical" dependency. If this were the case, then following a prolonged period of abstinence, there would be no concern of relapse -- the once dependent individual has no "physical addiction" to opioids to speak of.

If you would like to know the difference between "physical" dependency to opioids and "physical and psychological" dependency to opioids, I would suggest the following treatment schedule:

1. Take the OTC medication loperamide, which is an opioid agonist that cannot cross the BBB.
2. 1 week washout
3. Take heroin every 8 hours for two weeks
4. 1 week washout
5. Report back if you noticed a difference between heroin and loperamide.

> I wonder if someone could psychologically be hooked on using something like Lidocaine to numb every bruise or injury they get just to numb the pain.

Yes, but not for the reasons you are thinking.

Local anaesthetics act locally, and are the functional equivalent of a reversible lesion to the nerves they are acting on. Anything that an individual finds pleasant can become "addicting", but with respect to lignocaine, it's prudent to note that if it were addictive, it would have nothing to do with any action centrally.

> I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting.

Cocaine is still used in ENT surgery, as it is an highly effective vasoconstricting agent.

Its addictive properties, however, are largely thought to be limited to the "psychological" space. Yes, I state that in full appreciation for the above regarding physical. This is not to say that an individual does not have "physical symptoms" e.g. tiredness, but that these symptoms have a locus somewhere in the brain.

> This makes me wonder if physical withdrawal and hunger cravings are similar.

One concept in neuroscience/neuropsychology is the *somatic marker hypothesis* by Dimasio, which proposes that our behaviours/decisions are effectively guided by somatic, or physical sensations that are strongly linked to our emotions.

Thus, the body's need for food would instantiate a physiological state of discomfort that drives us behaviourally to seek food.

Likewise, the body's need for more IV heroin, would evince its own set of "somatic markers" likely to guide one's own behaviour towards the acquisition of more intravenous heroin.

See below:

> [The somatic marker hypothesis: A neural theory of economic decision](https://doi.org/10.1016/j.geb.2004.06.010)
>
> Modern economic theory ignores the influence of emotions on
> decision-making. Emerging neuroscience evidence suggests that sound
> and rational decision making, in fact, depends on prior accurate
> emotional processing. The somatic marker hypothesis provides a
> systems-level neuroanatomical and cognitive framework for
> decision-making and its influence by emotion. The key idea of this
> hypothesis is that decision-making is a process that is influenced by
> marker signals that arise in bioregulatory processes, including those
> that express themselves in emotions and feelings. This influence can
> occur at multiple levels of operation, some of which occur
> consciously, and some of which occur non-consciously. Here we review
> studies that confirm various predictions from the hypothesis, and
> propose a neural model for economic decision, in which emotions are a
> major factor in the interaction between environmental conditions and
> human decision processes, with these emotional systems providing
> valuable implicit or explicit knowledge for making fast and
> advantageous decisions.


---

