Pain Treatment Options: The Truth about Opioids

Recent news surrounding opioid drugs and treatments have caused alarm among healthcare professionals and people living with pain.

Listen to Dr. Cherrick talk about potential treatment approaches. You need Adobe Flash Player to view the videos on this site. Download the Flash plug-in at http://www.adobe.com/products/flashplayer/

Because of the potential for abusive and/or addictive behavior, many healthcare professionals have been reluctant to prescribe opioids for their patients. And for those who are prescribing these types of medications, there exists the added scrutiny from law enforcement officials may be wary of the drug's legitimacy and effectiveness in treating patients. This prescribing environment is one of many barriers that may contribute to the undertreatment of pain, a serious problem in the United States. The Society for Neuroscience, the largest organization of brain researchers, estimates that 100 million Americans suffer from chronic pain.

If you suffer from pain, it's natural to want to know the truth about opioid therapy. It's even more important that you talk to your healthcare professional about whether or not these pain treatment options are right for you. Below is information about the history of opioids and how opioids may be used as pain treatment options today.

A Brief History of Opioids (o-pee-oids)

Opioids are commonly prescribed medications due to their effective analgesic, or pain-relieving, properties. Today's opioid treatments derive from an ancient substance that has been around for thousands of years to treat pain: opium. Opium in its natural form is actually a bitter, brownish granular powder that comes from poppies.

It was the Ancient Greeks who first identified opium and extracted it from the poppy flower and the juice extract of the poppy plant. The word "opium" is translated from Greek meaning "juice." While the Greeks used this drug for a long time thousands of years ago, it wasn't fully defined and understood by scientists until the year 1817.

At that time, opium was cultivated and used mainly in the Middle East, whereas in Europe and the United States it was a luxury afforded only by the wealthiest individuals. However, opium and opium-derivatives quickly became more accessible to the general public and, once introduced into mass production, became a sought-after product used to treat a variety of ailments including colic, diarrhea, dysmenorrhea, and other painful conditions.

The availability of opium and opium-derivatives lead to the rise in "street use" of opium and heroin, causing a negative impact on society. As a result, legal controls were introduced. In the United States, the first attempts to control the abuse of opioids came at the end of the 19th century, when a few states instituted limited controls. By the 1940s, opioids were so tightly restricted that they could be used legally only when they were prescribed by physicians according to strict regulatory controls.

The legal use of opioids was thus placed entirely in the hands of physicians who were, and still are, liable to lose their medical licenses and are at risk for criminal prosecution if they prescribe these drugs inappropriately.

Today, the use of opioids as pain treatment options and the practice of prescribing these drugs are still highly regulated and scrutinized. And while the efforts of advocates of pain control have helped to reestablish opioids as invaluable and accepted acute pain treatment options, such strict regulatory control has made many physicians reluctant to prescribe opioids. The unfortunate casualty in all of this is the patient, who is often under-treated and forced to suffer in silence.

Opioid Therapy

When treating patients diagnosed with moderate to severe pain, opioids may be considered part of the pain management plan, along with other non-opioid analgesic and rehabilitative pain treatment options.

Examples of these medications include fentanyl, levorphanol, methadone, morphine and oxycodone.

The primary goals of opioid therapy should be established to emphasize both "meaningful" pain relief and "measurable" improvement gains in physical and social function. Prescribers should always take a balanced approach when prescribing opioids and consider pain treatment options that will provide patients with the most effective relief. A careful assessment of potential risks for addictive disease, abuse, and diversion should also be taken. Prescribers who have not been thoroughly trained in prescribing opioids, or who are uncomfortable prescribing these medications, may want to refer patients to pain specialists.

Myth vs. Reality

Listen to Dr. Fishman address some of the myths around the use of opioids as pain treatment options.

 

Managing Side Effects of Opioids

Listen to Dr. Fishman talk about the side effects of pain medication.

 

 

 

 

 

 

 

 

 

 

The most common side effects of opioids include constipation, nausea and vomiting, sedation (sleepiness), mental clouding, and itching. Some people may also experience dizziness or difficulty urinating. Respiratory depression, a decreased rate and depth of breathing, is a serious side effect associated with overdose.

The good news is that most side effects go away after a few days. However, side effects may continue in some people. Constipation is the most likely to persist. Some pain experts believe all patients started on an opioid also should be taking a stool softener or a laxative. Others believe that this treatment is appropriate only if a patient is prone to developing substantial constipation because of advanced age, poor diet, other diseases, or the use of other constipating drugs. Your healthcare professional can give advice on what to eat and what medicines to use to treat constipation. Always make certain to drink plenty of fluids and be as active as possible.

If any of the other side effects don't go away, they can also be treated. Be certain to tell your healthcare professional if you are having any problems. Serious side effects such as delirium or respiratory depression can occur if the dose is increased too quickly, especially in someone who is just starting to take opioids. Tell your healthcare professional if you are unable to concentrate or think clearly after you have been taking an opioid for a few days. Report other medications you may be taking that make you sleepy. Do not drive when you first start taking these drugs or immediately after the dose has been increased. Most persons will adapt to these medicines over time and can drive safely while taking them for pain control. If side effects remain troublesome, your healthcare professional may switch you to a different opioid. The amount of pain relief can be maintained after such a switch and often the side effects can be reduced.

Listen to Dr. Cherrick talk about ways to address opioid-induced side effects.