According to the Mayo Clinic, an estimated 5 to 8 million Americans use opioids for chronic pain. That’s a lot of people taking prescription medication. Prescription opioids have become the most abused class of drugs in the U.S.1
For this reason, physicians are more reluctant now to prescribe opiates liberally. In fact, because of the epidemic of opiate abuse, medical literature is changing protocols when it comes to prescribing opiates for chronic non-cancer pain to attempt to curb the risk of addiction, abuse and overdose of opioids by patients who have been prescribed them for pain management.1,2
And while abuse and over prescribing are not small issues when it comes to opiate use and your chronic pain patients, there is also a slew of negative side effects from opiates that can plague users. Short-term side effects include drowsiness, slowed breathing and respiratory issues, constipation and nausea, while long-term effects can result in physical dependence, cardiovascular disorders, addiction and tolerance.1
Up to 80% of patients taking opioids experience at least one side effect. The most common being gastrointestinal problems like constipation, nausea, and vomiting. Central nervous system side effects are also common, like impaired concentration, confusion, sleep and memory problems. With ongoing usage, a tolerance can develop to some of the side effects but constipation does not subside and typically has to be treated.3
Opioids may also cause dry mouth, excessive sweating, and weight gain, loss of appetite, sexual dysfunction, and dry skin.3
Often patients with chronic pain have accompanying psychiatric disorders such as depression, anxiety and negativity. And patients with chronic pain who have major psychopathology may report greater pain intensity, more pain-related disability and higher levels of emotional stress regarding their pain, compounding these negative side effects.1 About 10% of patients actually develop depression while taking opioids.4
Ironically, opiates can also increase patient’s pain. This is a phenomenon that is not well understood, but after taking an opioid, some patients can quickly experience more pain than before they took the medication. When patients have this side effect, they typically must explore other pain management options, as opioids will not be effective in their case.4
Additionally, your patient’s immune system can also be compromised while on opiates. The body’s ability to fight off infection weakens immediately upon taking opioids, even if patients don’t experience the effects of a compromised immune system for months; they may become sick later.4 The best way to manage this side effect is to stop the opioid.
Without even taking abuse and overdose of opiates into account, these are serious enough side effects as to warrant providers to carefully consider the risk and benefits of opioid therapy and avoid frequent dose escalations, high dose therapy as well as terminate therapy if not effective, use short therapy durations, and explore alternative methods of pain management.3,4
The latest research also shows that when providers receive up-to-date information about opioid prescribing , and make necessary adjustments to their prescribing protocols, there is a decline in opioid-related deaths in the patient population.3
Organizations such as the Centers for Disease Control and Prevention now have guidelines for primary care providers as well as other specialty physicians outside of cancer and palliative care on both when to initiate opioid therapy as well as assessing the benefits and harms. These guidelines can help improve communications and open the door to discussing these issues with your patients.
Pain and pain management is a complex and individual problem in the patient population and the benefits and many side effects of opiate therapy must be weighed fully in addition to exploring newer and alternative pain management modalities.2
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Further Reading:
THE VALUE OF SHARED DECISION-MAKING IN THE MANAGEMENT OF CHRONIC PAIN
The management of chronic pain often relies heavily on physician-directed treatment decisions, rather than shared decision-making and patient participation. In many ways, the opioid epidemic is pushing the medical community to reflect on this disparity, and specifically on what appears to be the practice of overprescribing narcotics…
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1 Jamison, R. Opioid analgesics. Mayo Clinic. 2015 July [cited May 2018]; 90(7): 957-968. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(15)00342-0/fulltext
2 Dowell, D. CDC guideline for prescribing opioids for chronic pain — United States, 2016. Centers for Disease Control and Prevention Recommendations and Reports. 2016 March [cited May 2018]; 65(1);1–49. Available from: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
3 Sehgal, N. Chronic pain treatment with opioid analgesics. Medscape. Expert Rev Neurother. 2013 [cited 2018 May];13(11):1201-1220. Available from: https://www.medscape.com/viewarticle/813875_4
4 Family Health Team. The down side and side effects of pain killers. Health Essentials. 2013 July [cited May 2018].