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Opioids and Chronic Pain

What are Opioids?

Opioids are strong medicines that are widely used in moderate to severe pain. Examples of opioid and opioid-like medications include morphine, hydromorphone, methadone, fentanyl, hydrocodone, oxycodone, codeine, tramadol, and buprenorphine.

What can Opioids be used for?

Opioids are often helpful for acute injury and cancer related pain. The value of using opioids for managing chronic pain is less clear.  Chronic pain is generally defined as pain lasting longer than the expected recovery time from an acute illness or injury.  If you have been using opioids for a long time, you and your doctor may want to review the benefits and the risks of these agents for your condition.

What are some of the risks of long term opioid use?

  • Opioid induced hyperalgesia.  Opioid medication aimed at managing pain may make you more sensitive to pain and can actually make your pain worse, even when the dose is increased.
  • Constipation.  Opioids often cause slowing of bowel movements.  Chronic constipation can lead to hemorrhoids, rectal pain and burning, bowel obstruction, and potential bowel rupture.
  • Hormone changes.  Hormones are special chemicals made by your body that help it work normally.  The amounts of hormones, such as estrogen or testosterone, could get higher or lower.  This can cause problems with fertility and change in mood and sexual drive in both men and women.  Opioids can also affect a woman’s monthly period.
  • Osteoporosis. Long term use of opioids can weaken bones and increase your risk of fractures.
    Problems with your immune system.  Your immune system may not work as well as it should.  You may get more infections than you would if you did not use opioids.
  • Sleep disturbances.  Sleep problems such as sleep apnea may occur after using opioids for a long time.  Sleep apnea is when you stop breathing for periods of time while asleep.
  • Tolerance.  This means over time your body can get used to the medicine.  The opioid might not be able to control your pain as well as it used to.  The pain may come back sooner.  You might need more of the opioid medicine to give you the same amount of pain relief, exposing you to greater risk of having more side effects.
  • Addiction. You are at risk for addiction even if you are using your opioid medication responsibly and per doctor’s orders. Your risk of becoming addicted to opiates can increase if you use tobacco, alcohol, other addictive substances, and/or have a family history of addiction.
  • Cognitive and mood changes.  Opioids can shut down part of your brain (frontal lobe) and the emotional part of your brain (limbic system) can become more active.  This can lead to memory loss, emotional instability, mental fogginess, and cause you to have less energy.

If there are so many risks associated with the use of opioids for chronic pain, why did my previous providers continue to prescribe this for my pain? 

Medical knowledge is constantly growing.  There are a number of effective approaches to manage chronic pain.  We continue to refine our approaches as more knowledge is gained about the best ways to treat chronic pain.

Why should I consider tapering as part of my overall pain treatment plan 

The use of medications often provides temporary and less relief over time, and may contribute and/or worsen other problems.  Patients have been able to develop a wellness plan that does not include the use of opioids.  These patients go on to lead functional, fulfilling lives, without depending on opioids, and report feeling better when they are off the opioids.

How would my pain be managed?

The good news is, medication is only one part of effective pain management.  A combination of approaches is often the best way to manage your pain. Helpful activities include mindfulness training, movement, awareness of posture and body mechanics, modification of activities, and the development of relaxation techniques that include body scanning and awareness of bodily sensations.

I want to stop opioids, but I don’t know how, and I’m worried about withdrawal.

Withdrawal is a common effect of stopping opioids.  It occurs because your body is used to taking the medication for a long period of time, and when you stop the medication, you may get flu-like symptoms, such as sweating, runny nose, gooseflesh skin, diarrhea, and stomach cramping. It is normal to have an initial increase in pain as part of withdrawal. If you have these symptoms, don’t be alarmed.  These symptoms are temporary and not life-threatening. If long term use of opioids is not right for you, it may be recommended for you to taper off of opioids as part of your pain management plan.

Finding the right treatment plan for you

We are committed to your good health.  We know that each person’s pain is unique, so the best
pain management begins with a conversation with your personal doctor.  You can partner with your doctor and health care team to find the treatment plan that works best for you.