Opioids are the most commonly prescribed class of medication in the United States, and are most often used for the short-term relief of chronic pain1, 5. Opioids are a broad class of medications that act on specific opiate receptors to induce opium or morphine-like effects, which therapeutically produce analgesia (pain relief)3, 6.
Opioids are generally prescribed to patients with moderate or severe pain that negatively impacts their quality of life, persists for several weeks, and/or is unresponsive to other pain relievers such as; acetaminophen (Tylenol®) or ibuprofen (Advil®)1, 5. Common opioid medications include morphine, codeine, oxycodone, oxycontin, hydrocodone, methadone, and fentanyl. Analgesic effect is the same among different opioids; however the potency and side effects of the various drugs can differ6.
For years the benefit of opioid therapy has been well established for severe, sudden onset pain and pain associated with cancer; however the benefits of opioid use for chronic pain remain controversial5. Studies have shown benefits for chronic pain from short-term opioid use, however long-term benefits are unclear1.
While opioids offer the potential for effective pain relief for many patients, there is a potential for misuse due to its additional euphoric effects1, 3. Opioid misuse makes management of chronic pain difficult, and abuse of these medications amongst chronic pain patients has been a growing public health problem in recent years2. Because of this, many physicians restrict and/or closely monitor their prescription of opioid medications, particularly for patients with a history of alcohol or other drug-related abuse. Additionally, high dosages and/or opioid misuse often results in overdose which can cause life-threatening depression of respiration and the central nervous system3, 5.
If opioid therapy is indicated, the physician will assess the potential risks and benefits of treatment, including the risk of future abuse and dependence5. A history of alcohol or drug abuse for the patient or close family is the strongest predictive factor for opioid misuse, and may necessitate evaluation by a substance abuse specialist and/or psychologist. Despite these risks, opioid therapy can be used safely and effectively in properly screened patients5.
To reduce the risk of abuse and dependence, doctors will often ask patients to comply with monitoring programs, particularly at the start of therapy5. These opioid contracts help ensure that patients are well informed as to the benefits and risk of opioid therapy and adhere to the treatment program. They also improve the management of pain and have been shown to result in a modest decrease in misuse5. Common elements to these agreements include5:
- Opioid information
- Goals and expectations
- Single pharmacy to fill prescriptions
- Single physician for prescriptions
- Random urine screenings
Like many medications, opioids can have unpleasant side effects such as4, 5, 6:
- Breathing difficulty
Many of these side effects disappear with time or can be managed with dosage adjustments and additional medications as necessary5.
Opioid therapy is a short-term solution for moderate to severe pain; thus the use of opioid medications should not exclude other possible longer term treatment options5.
- Martell, B.; et al. (2007) Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine. Vol. 146 (2) 116-127.
- Ives, T.J..; et al. (2006) Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Services Research. Vol. 6 (46) 1-10.
- Blok, B.; et al. (2010). Opioid toxicity. First Consult. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu/das/pdxmd.
- American Academy of Family Physicians. (2008). Pain Control after surgery: Pain medicines. Patient education. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu/das/patient
- Bajwa, Z.H.; Smith, H.S. (2011). Overview of the treatment of chronic pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Tietze, K.J.. (2011). Pain control in the critically ill adult patient. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.