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Opioid Pain Relievers: Managing Chronic Pain

August 14, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

This is the second in a series of articles about opioid painkillers. Although opiate overdoses (especially heroin) are frequently in the news, how much do you actually know about these medications and how they are used to manage acute and chronic pain? 

Pain is the most common reason people seek medical treatment. In fact, 100 million Americans have chronic pain and many are treated with opioid painkillers, some for long periods of time.

The information in this article is from the American Academy of Family Physicians, the Cleveland Clinic, and the National Institutes of Health. It’s important to note that the management of chronic pain is complex and individual; and this article only touches on the basics.

Some Pain Definitions

Acute pain is pain that comes on quickly, can be severe, but lasts a relatively short time and is usually associated with an injury; a surgical or dental procedure; or, some type of illness, such as the muscle aches and pains from influenza. Acute pain usually subsides when the cause is treated or the illness runs its course.  

Chronic pain is ongoing or intermittent pain that lasts beyond the usual course of an acute illness or injury or more than 3 to 6 months, and which adversely affects an individual’s well-being. Chronic pain may interfere with your daily activities. And because the pain lasts so long, people who have chronic pain may also have low self-esteem, depression, and anger. 

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists; pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap, such as a sprained back, or there may be an ongoing cause of pain, such as arthritis or cancer — but some people suffer chronic pain in the absence of any past injury or evidence of body damage. 

Common chronic pain may include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves, such as diabetic neuropathy), or psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).  Sometimes, chronic pain is caused by an old injury or infection, or by a disease. Sometimes there is no known cause for the pain. Depression and stress tend to make pain worse, including chronic pain.

Chronic Pain Management

Your physician (or other healthcare provider) will talk to you about your pain—where it is, how bad it is, how often it occurs and what makes it better or worse. This information will help your doctor work with you to diagnose your pain and develop a plan to treat your pain and help you manage your symptoms.

Your physician will ask you about your medical history, including a family history of alcohol or drug abuse, do a physical exam and possibly order tests to help determine the cause of your pain. Your doctor will also review other health problems you may have (such as breathing problems and heart conditions) because these may keep you from doing some types of therapy. Your doctor may also ask if you have had any problems with sleep, mood, or anxiety.

Treatment of chronic pain usually involves medications and therapy. The goal of treatment is to reduce how much pain you have and how often it occurs. Usually, chronic pain treatments do not take away all of your pain. 

Medications used to treat chronic pain include pain relievers, antidepressants, and anticonvulsants; different types of drugs help people who have different types of pain. Your doctor usually will recommend long-acting medications for constant pain. Your doctor may recommend an over-the-counter pain reliever (such as Tylenol or Advil) or a prescription pain reliever (such as Oxycontin, Percocet or Vicodin). Make sure to follow your doctor’s instructions for how to take these medications. If used incorrectly, the prescription painkillers relievers can increase your risk for side effects or addiction. And, make sure to safely store these medications to keep them out of the hands of family members or friends who might misuse them. If you have medications that you are no longer using dispose of them in the kiosk in the lobby of the police department.

Drugs Are Not the Only Way to Treat Chronic Pain

There are many other things you can do to help relieve your pain, and these may actually work as well if not better than prescription medication. Almost anything you do to relax or get your mind off your problems may help you control your pain. It's important to include relaxing activities in your daily life, which can actually change the body's chemicals that produce pain. You might have to use stress-reduction methods for several weeks before you notice a decrease in pain. Your doctor can give you tips about stress reduction and relaxation methods.

Depending on the cause, several types of therapy can help ease your pain, including physical therapy, such as stretching and strengthening activities; and, low-impact exercise, such as walking, swimming, or biking.

Some types of chronic pain can be helped by osteopathic manipulation therapy or acupuncture. Occupational therapy teaches you how to pace yourself and how to do ordinary tasks differently so that you reduce your pain or avoid reinjuring yourself. Behavioral therapy can reduce your pain through methods that help you relax, such as meditation, tai chi, and yoga. It can also help decrease stress.

Lifestyle changes are also an important part of treatment for chronic pain; getting regular sleep, a healthy diet, regular exercise, and engaging in social activities. 

6 Myths About Prescription Painkillers

Opioids, such as Oxycontin, Percocet, and Vicodin are the most commonly prescribed pain medications; and, there is a lot of misinformation online and in social media. In a recent copy of its online consumer health newsletter, The  Cleveland Clinic, debunks six common myths:

Myth 1: The more you take, the better they work

More does not equal better. It’s true that in the short term — after a severe injury, for example — two pills may be more effective than one at relieving pain. But over time, taking too much backfires. Research suggests that pain medications may do something to desensitize the way your brain and spinal cord interpret pain signals. You may develop a tolerance to the medication over time and sometimes if you take chronic pain medications for a long time, your pain may actually get worse.

Myth 2: If you take them for a valid reason, you can’t get addicted

“It can’t happen to me. I’m a good citizen. I’m a normal person. I couldn’t possibly get addicted.” Thinking this way is dangerous. Even if you start taking a prescription pain medication for a legitimate reason, you run the risk of addiction. It has nothing to do with moral character and everything to do with the highly addictive nature of these drugs. 

Myth 3: Everyone who takes them gets addicted

On the flip-side, just because you take a prescription painkiller does not mean you will become addicted. It depends largely on your own personal risk of addiction. That’s why your physician screens for risk factors such as a family history of addiction, a personal history of alcohol and drug abuse, or certain psychiatric disorders. Your doctor may say, “If I’m considering prescribing opioids, I’m going to do drug screening and make sure you’re not taking recreational drugs. If somebody uses recreational drugs, the likelihood they’re going to use pain medications inappropriately is very high.” Not everyone gets addicted, but everyone who takes painkillers for an extended time period will experience symptoms of withdrawal when they stop, it’s a natural reaction. 

Myth 4: There are no long-term consequences

Addiction is not the only risk that comes with prescription pain medications. When taken for extended periods of time, they also can harm your body’s endocrine system and throw your hormones out of whack, affecting everything from your libido to your risk of osteoporosis. 

Myth 5: You should avoid painkillers altogether

As you can tell, there is plenty of scary information about painkillers. However, there are certainly legitimate uses. In addition to treating the pain from acute injuries, a small fraction of patients with chronic pain see improvements in both pain levels and function from taking pain medications. For the majority of people, though, prescription pain medications should be a short-term treatment at most.

Myth 6: Pain medication can fix your pain

This may be the biggest myth of all. Pain medications simply mask your symptoms; they don’t treat the root cause of your pain. Your physician may focus on how you function rather than just how you feel. Are you moving better? Are you able to get back to work? These are important questions about function. So is the question of whether you’ve been making efforts to get better. For example, have you been following your physician’s recommendations and doing physical therapy to recover from an injury?  If you’re not doing the other things you need to do, your doctor may not keep prescribing painkillers, since on their own, they are probably not the best therapy.

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