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Opioids for the Treatment of Chronic Pain: What You Need to Know

Last month a White House panel called our country’s epidemic of opioid addiction and overdose deaths a “national public health emergency.”

It’s an ongoing and escalating disaster with an estimated 3.8 million Americans using opioids for non-medical reasons every month and 142 Americans dying every day from overdoses. Opioid overdose is now the leading cause of death for Americans under 50. Non-fatal overdoses that require emergency medical care are even more prevalent and have increased by a factor of 6 in the past 15 years.

Historically, opioids have been safely and effectively prescribed for acute trauma, before and after surgery, cancer pain and pain associated with end of life illness. However, we have seen a major change over the past couple of decades, with opioids being increasingly prescribed for many non-acute (like chronic back pain) conditions. Alarmingly, more than half of those patients receiving opioids therapy for chronic pain for more than 90 days are still receiving opioids more than 4 years later.

As a result of these disturbing trends, there is an increased sense of urgency among medical professionals to develop more stringent guidelines for the use of opioids and to offer pain treatment options that do not require the use of highly addictive drugs.

Addiction is a deadly and chronic illness and once addicted, people need to fight the disease and its cravings one day at a time for the rest of their lives. There can be no purer example of the wisdom of the adage: “An ounce of prevention is worth a pound of cure”

Evidence supports the use of opioids for treating acute pain, however, “the evidence is limited for the use of chronic opioid therapy for chronic pain.”  Acute pain is the body’s warning signal that something is wrong and needs immediate attention. Chronic pain, on the other hand, may be a different kind of signal requiring a different response. Using powerful and addictive painkillers, in this situation, may only add to the problem because increasingly higher doses are often needed to control the pain.

The American Academy of Family Physicians, while recognizing that opioid therapy benefits some patients with chronic pain, is urging its members to discuss the risks and benefits in a much more detailed way with patients. They recommend that physicians share the following explicit warnings in any discussion with patients regarding the advisability of using opioids for pain management:

  • “This medicine is usually used to relieve pain. But if you take it every day for a long time, it can make your pain worse. It can even cause pain in parts of your body where you didn’t have pain before.”
  • “When you first start taking this medicine, it will probably work well to reduce your pain. But if you take it every day for a long time—weeks to months—it may stop working. You may find that after a while, your pain is as bad as before you started the medicine.”
  • “Your body may become dependent on this medicine. That means that if you don’t take it or you take less than your usual amount, you may experience withdrawal. Withdrawal can feel like a bad case of the flu, including hot and cold sweats, diarrhea, feeling like you need to throw up, not being able to sleep, and feeling down or nervous. You may also have aches all over your body. For some people, withdrawal makes them feel like they might die. But people rarely die from opioid withdrawal.”
  • “This medicine can kill you by slowing down your breathing and your heart rate until you stop breathing and your heart stops beating. The more you take, the more likely this is to occur, even if you’ve been taking it the same way for a long time. The risk increases if you take this medicine with alcohol or other drugs that cause sleepiness. Also, if you take high doses of this medicine after you haven’t taken it for awhile, you are at increased risk of overdose because your body loses the ability to tolerate high doses.”

In summary, if you, or someone you care about, are one of the estimated 100 million people with chronic pain you have good reason to be concerned about the addictive risk which comes with being prescribed an opioid. It is important that you discuss all the potential risks and benefits thoroughly with your physician.

The good news is that the development of effective and safe alternatives is now a top priority among researchers and specialists are exploring a range of nondrug, noninvasive treatments which are proving effective in relieving the many chronic pain problems like- back pain, fibromyalgia, severe headache, knee arthritis and neck pain.

In my next post I will summarize some of the research on the effectiveness of these alternative nondrug treatments.

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