Chronic pain is a complicated issue. Defined as pain lasting longer than three to six months, chronic pain has no simple fix. Recent research on pain treatments and protocols has called into question indiscriminate use of opioids as a pain reliever for chronic pain patients. These painkillers have risks that researchers are finding can outweigh the potential pain-relieving benefits.
Some of the risks and side effects associated with these types of painkillers are as follows.
Loss of efficacy
Over time, the opioid receptors in the brain get used to the presence of the opioids in the body and require a higher dose to respond. Higher doses of opioids lead to a higher risk of side effects.
High risk of dependence
More than any other painkiller, opioids have a high risk of dependence, due partially in fact to their fast-acting nature plus the potential for loss of efficacy. Those patients with previous drug dependence issues are most at risk for this.
Sleep apnea or depressed breathing
Opioids are sedative, and this sedation can sometimes result in sleep apnea or depressed breathing. Sleep apnea occurs when the patient stops breathing during sleep. This can be a life-threatening issue. It also produces less quality sleep, and sleep deprivation increases a patient’s perception of and reaction to pain.
Low estrogen and testosterone
Opioids depress the production of these hormones. For men, this can result in a lowered sex drive. Women may see a change in their menstrual cycle or may stop menstruating altogether.
The use of opioids also acts on the salivary glands, making the mouth very dry. This can affect oral hygiene, which has been linked to heart disease and other serious conditions.
This is one of the most common side effects of opioid use, with 60% of patients who use opioids experiencing some level of constipation. The same pain-blocking action that opioids perform in the brain are also performed on the bowels. KU Leuven announced in the New England Journal of Medicine that naloxegol was successful in relieving constipation without dampening the pain-relieving effects of the opioids. This study is just out of stage three trials and is awaiting approval in the United States and Europe.
For some patients, the benefits of opioids outweigh the painkillers’ risks. Patients suffering from cancer pain or those who are having acute pain conditions where short-term prescriptions prove to be effective find the most benefit. Opioids are also well-prescribed for palliative care.
In other cases, opioids may be dangerously over prescribed. The American Academy of Neurology published a position paper in the September 30, 2014 issue of Neurology. They believe that the risks associated with opioids far outweigh any benefit that patients with low back pain, headache, and fibromyalgia may receive. Gary M. Franklin, MD, MPH, research professor in the Department of Environmental & Occupational Health Sciences in the University of Washington School of Public Health in Seattle and a fellow with the AAN had this to say about the risk of death and curtailing prescriptions:
“More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use. There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions and patients need to work together to stop this epidemic.”
Franklin cites studies that indicate that 50% of patients who take opioids for three months remain on them five years later. The AAN has put together a prescription protocol that includes consulting with pain specialists, careful review of previous or current drug use history, counseling and monitoring for depressive disorders, and tracking daily opioid use.
Another report from Brandeis University also believes that insurers bear some responsibility in tracking and monitoring prescriptions to reduce painkiller risks of abuse and overdose. Peter Kreiner, principal investigator of the Prescription Drug Monitoring Program (PDMP) Center of Excellence, notes:
“At a time when the misuse and abuse of prescription opioids has reached epidemic levels, it’s important that third party payers be able to use states’ prescription monitoring data to make sure these drugs are prescribed appropriately.”
Opioid painkiller risks may even outweigh the benefits for use in surgical sedation. Opioids may actually suppress the immune system response after surgery, according to a study led by the Mayo Clinic and published in the British Journal of Anaesthesia. Researchers found that using a spinal or epidural painkiller before surgery instead of just relying on general anesthesia may reduce the need for opioids during recovery.
Senior author Juraj Sprung, M.D., Ph.D., a Mayo Clinic anesthesiologist said, “We found a significant association between this opioid-sparing technique, reduced progression of the prostate tumor and overall mortality.” Not only did reducing the amount of general anesthesia during surgery improve post-operative pain, but it also improved post-operative outcomes.
Because of all of the research supporting reducing opioid prescriptions, it is easy to recommend not using them. But what other alternatives are there? Patients dealing with daily chronic pain may feel that painkiller risks are worth it. It is important to offer alternative methods either as a substitute or complementary therapy for pain relief.
Changes in diet
While relief may not be immediate, removing inflammation-causing foods like sugar, wheat, and dairy and adding inflammation fighting food like ginger, turmeric, and tart cherries may help the body fight pain naturally.
Mindful meditation is gaining traction as a research-supported method for boosting mood and helping patients deal with pain. For patients who have been on opioids and are trying to reduce or eliminate them, mindfulness can help patients to focus on the positive aspects of their lives rather than the painful ones.
The University of Utah Health Sciences has published a study in the Journal of Behavioral Medicine corroborating this theory. A group of chronic pain patients who went through an eight-week course on mindfulness techniques displayed positive responses in their brains to healthy pleasures. They reported reduced craving for opioids and higher sense of contentment and overall appreciation of their lives.
An increase in exercise, however slight and regardless of intensity, can have a positive effect of levels of chronic pain. Chronic pain patients are often hesitant to exercise for fear that exercise will cause more pain, but research indicates that regular, moderate exercise decreases chronic pain.
Painkiller risks increase exponentially not only by taking too much but also by taking too little. If patients are prescribed medicine, it is important that they follow the prescription directions. A British study found that something as simple as a text reminder was enough to help patients remember to take their medicine. If you are taking opioids for chronic pain, it is important to follow the prescription directions exactly. Do not combine opioids with other medications without talking to your doctor or pharmacist, and do not drink when taking your prescription. Smoking is also a risk factor due to the side effect of depressed breathing. If you are on prescription opioids, now might be a good time to quit smoking.
Other complementary treatments such as acupuncture, biofeedback, and float tanks can have profound effects for chronic pain patients without the painkiller risks associated with opioids. Talk to your doctor to design a treatment protocol that is right for you.
Does your doctor follow an opioid prescription protocol? Find out!
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