For years, people across the globe have struggled with the contradictions of opioid pain relievers. When first introduced, these “miracle drugs” seemed to be the answer for so many people struggling with pain conditions. As the number of prescriptions mounted and time passed, however, the picture became grim. Rates of addiction, dependence, side effects, and overdose rose. Unfortunately, growing numbers of people using these medications still experienced unrelieved chronic pain, but were unable to go without their prescription. For other patients, opioids provide comfort and respite from acute pain or pain from terminal illness. Opioids are complicated. Here’s what we know and our approach to prescribing them.
What are opioids?
Opioids are the most commonly prescribed class of medication in the United States and are most often used for the short-term relief of pain. This broad class of medications acts on specific opiate receptors in the brain to induce opium or morphine-like effects, which helps temporarily dull pain.
Opioids are generally prescribed to patients with moderate or severe pain that negatively impacts their quality of life, persists for several weeks, or is unresponsive to other pain relievers.
The benefits of opioid therapy have been well-established for severe, sudden onset pain and pain associated with cancer. But, the benefits of opioid use for chronic pain remain controversial. Studies have shown benefits for chronic pain from short-term opioid use, but not for long-term use. It’s for this reason that we work to reduce patient use of opioids at Arizona Pain with our opioid management protocol.
Opioid side effects
Like many medications, opioids can have unpleasant side effects that include the following:
- Breathing difficulty
Many of these side effects disappear with time or can be managed with dosage adjustments and additional medications as necessary.
However, one of the major risks of opioids is the possibility for dependence. The action of opioids on the brain is such that, even when taken for a short period of time, addiction can occur. Older adults and those with a family history of addiction are most at risk of dependence, but it can occur for anyone.
The research on opioids for pain management
Opioid misuse makes management of chronic pain difficult, and abuse of these medications among chronic pain patients is a growing public health crisis. Because of this, many physicians restrict or closely monitor their prescription of opioid medications.
In the U.S., three million people have been (or currently are) addicted to opioid pain relievers. This addiction is costly both in terms of lives lost and economic impacts. An estimated 130 people per day lost their lives to prescription opioid overdose in a three-year study. Economic impacts, including lost wages and productivity plus actual healthcare costs, reach nearly $79 billion dollars annually.
Adding to this is the fact that research indicates that opioids are not effective in managing long-term, chronic pain. The numbers don’t lie. The effects of opioids after a longer period of time work more as a placebo than actual pain relief, and the associated risks can do more harm than good.
The flip side of this tragic coin is that for some conditions, prescription opioids provide relief and peace for patients. For terminal cancer patients, for example, prescription opioids are often the only medication that allows them rest in their final moments. And for acute pain or painful surgical procedures, opioids allow the body time to recover and heal.
Increased restrictions on opioid prescribing that are designed to minimize their use and possibility for dependence can cause considerable alarm for patients struggling with end-stage cancer pain. Similarly, a heart surgeon would not think of performing surgery without the powerful effects of opioids. However, opioids—and opioid prescribing—is a complicated dance between pain relief and consideration of the long-term effects (and risks) for patients.
Can opioids be part of a pain management plan?
So, can opioids be part of a pain management plan? The not-so-simple answer: maybe.
As noted above, opioids are best used for short-term acute pain treatments or for terminal cancer pain. In the case of acute pain, opioid prescription should be overseen by a trained pain specialist. Many chronic pain patients with severe, intractable pain currently use opioids, too. Note that these patients should not stop use unless they’re working with their doctor to appropriately and slowly taper off dosage.
For all patients, there should be plans to reduce usage, and they should be used in concert with other therapies. When severe pain makes life unbearable, opioids may allow patients to get the short-term relief they need while undergoing other therapies. Therapies like interventional procedures, physical therapy, and chiropractic care can take time to produce results.
Even for intractable cancer pain, patients should be monitored by a pain specialist and incorporate other therapies to reduce pain. Dosages should be as low as possible for pain relief, and other treatments should be explored before turning to opioids.
To reduce the risk of abuse and dependence, doctors will often ask patients to comply with monitoring programs, particularly at the start of therapy. These opioid contracts help ensure that patients are well-informed as to the benefits and risks of opioid therapy and that they adhere to the treatment program. Opioid agreements also reduce the possibility of dependence slightly and seem to improve outcomes.
Common elements to these agreements include:
- Opioid patient information
- Treatment goals and expectations
- Single pharmacy to fill prescriptions
- Single physician for prescriptions
- Random urine screenings
The key to safe use of opioids is to take them only for appropriate types of pain, preferably on a limited basis, and working closely with your doctor for the duration of your treatment.
Our opioid therapy statement and compliance checklist
At Arizona Pain, we believe opioid therapy can be part of a treatment plan for some forms of pain. We always follow DEA rules and prescribing guidelines to keep our patients safe. Our goal is to design individual, comprehensive pain management strategies that are as minimally-invasive as possible and reduce our patients’ use of opioids.
Our opioid management tool outlines a 12-step checklist designed to monitor and protect those patients for whom opioid therapy is appropriate. Opioid therapy can be a short-term solution for moderate to severe pain, but we believe in conservative treatments and diligent monitoring during this treatment. We always work to uncover complementary pain treatments. Target the source of your pain, versus relying solely on opioids.