Opioids for Chronic Pain: More Harm Than Good?

Narcotic drugs for pain relief have been around for decades, but their benefit is still under doubt: is there a point to prefer opioids to traditional pain killers?

If you suffer from severe chronic pain, most likely, you have already tried everything to eliminate it. If nothing helps, taking opioids (narcotics) can be a solution. While traditional analgesics can cause side effects in case of long-term use, opioids are relatively safe when used under medical supervision. Before opting for narcotics, you should know some basic facts about them.

What Are Opioids?

Opioids are obtained in three main ways:

  1. Derived from plants.
  2. Produced in a lab.
  3. Appeared naturally in the human body.

Opioids are very efficient for management of severe pain, though they are not typically used to deal with acute pain, for instance, after surgery or caused by cancer.

Kinds of opioids

The choice of opioid depends on your health condition and individual body reaction to different medications. First, there can be long-acting or short-acting drugs. Secondly, opioids are administered orally, as a rectal suppository, in the form of a patch applied to skin, or intravenously.

While such medications as oxycodone and hydromorphone are “pure narcotics”, other drugs (for instance, Tylenol #3 and Vicodin) can be mixed with other pain killers. Antagonist opioids (buprenorphine and butorphanol) combine medications to reduce pain and reduce the risk of dependence.

Side effects and complications caused by opioids

Although some people can be stuck the same opioid dosage for years without developing tolerance to it or dependence, addiction remains the main concern. Some people who have to take narcotic pain drugs are wrongly labeled as “addicts”, which can be frustrating. Tolerance and physical addiction are only a few side effects caused by opioids. The others include the following:

  • constipation;
  • drowsiness;
  • nausea;
  • confusion;
  • problems with urinating;
  • difficulty breathing;
  • skin itching;
  • sexual dysfunction;
  • low blood pressure.

Opioids are more dangerous for children and elderly people rather than adults, so these groups of people should be monitored closely. As a rule, doctors start with a low dose and increase it gradually to reach the effect. Besides, opioids should be taken carefully with other medications to avoid side effects and overdoses.

Guidelines for Opioid Administration for Chronic Pain

Medical specialists give the following recommendations for safe use of opioids:

  1. Opioids should not be used for pain management in the first place. Start with non-opioid medications to relieve pain: ibuprofen, Neurontin, anticonvulsants and tricyclic antidepressants. If they are not helpful enough, you can use opioids together with other treatment approaches.
  2. Before resolving to take opioids, discuss all pros and cons with the doctor. You should clearly state all possible risks and benefits. Besides, it is crucial to determine the goal of therapy: do you need to improve some body functions, or quality of life?
  3. Try short-acting opioids before using long-acting ones.
  4. Start from the lowest dose prescribed (follow prescriptions labels and refer the tables that compare doses of various narcotics when you switch from one drug to another).
  5. Acute pain occurred on top of chronic pain is treated by a short course of narcotics.
  6. Visit your doctor once a week, or several times a month for regular examinations. Efficiency of medications used for a long term should be evaluated at least once in three months. If no relief is achieved, the course should be ceased. Urine drug testing is necessary: it shows that the person takes enough prescribed drugs and does not combine them with medications that can interfere with treatment.
  7. To decrease risks and side effects, a certain strategy of treatment should be followed. You can combine agonist/antagonist medications if a potential for abuse is high.
  8. If you are treated by several physicians, they should be provided with correct data about opioids you use and their doses. Thus, you can make sure they do not prescribe an amount of drugs that can cause overdose.
  9. Opioids are better not to be combined with benzodiazepines.
  10. In case of dependence, a physician should offer abuse treatment options.

Do You Really Need to Use Opioids?

Opioid use is a controversial issue: some doctors do not prescribe them at all. But some people find them effective for reducing severe pain when nothing else works. For such people, the benefits of narcotics overweigh the risks, and opioids help them to get back to normal life. Besides, addiction does not take place in every case.

Before you start taking opioids, you doctor should monitor your condition and get information about your medical background. You can go through an opioid trial and gradually increase the dose to reach desired effects. Regular monitoring is required to make sure that there are no serious complications.

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