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Opioid Pain Relievers: Talking with Your Physician

August 21, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

This is the third 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.

Aside from several side effects (such as constipation), the use of opioid medications (such as OxyContin, Percocet and Vicodin) can, if not used properly, cause addiction. The increase use of these medications has fueled an epidemic of prescription painkiller addiction and has led to a significant increase in heroin use in New England during the past five years. According to the Centers for Disease Control and Prevention (CDC), people who are addicted to prescription opioid painkillers are 40 times more likely to become addicted to heroin. 

If you are being treated for pain, it is very important that you have a discussion with your physician about the proper use of your pain medications and what outcomes to expect. Your doctor has the responsibility to work with you to develop a treatment plan for your pain  and to make sure that you are fully informed about all aspects of your treatment. 

More Information = Better Outcomes

Earlier this year a friend had orthopedic-related surgery and a three-day inpatient stay at one of the nation’s leading teaching hospitals in Boston. For 24 hours following surgery, she was given an intravenous painkiller, and then two days of an opioid medication by mouth. These medications controlled her pain. At the time of discharge, she was given an appointment for a follow-up with her surgeon in two weeks and a bag of 95 Oxycontin pills. During her discharge, no one talked about pain management, what side effects to look for, and how to properly store the medication. At home she needed to take the Oxycontin for three days and found that both Tylenol and Naprosyn along with cold packs helped her to manage her pain. By the time of her follow-up visit, she had used only 10 Oxycontin — the remainder was disposed of in the kiosk in the lobby of the Falmouth Police Department.

My friend was knowledgable about dealing with pain medications and on her own was able to manage her pain appropriately. Not having that information, might have put her at risk for side effects and possible dependence on the prescription painkillers as she continued to recover and go through rehab.

The following information is from the National Safety Council and the Bitter Pill campaign of the State of Indiana, a model for managing the opioid pill epidemic.

Working with Your Medical Provider

If you have an acute painful event, such as an injury, surgery or other medical condition, your physician may recommend an opioid prescription painkiller for you. Make sure to discuss this choice of medication, since there are risks taking opioids that you might be able to be avoid.

Ask your doctor if there is a non-addictive alternative. Depending on your injury or procedure, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be as effective as opioids and have less side effects. If you and your physician feel that a prescription painkiller is needed, ask if a three-day supply is appropriate.

For example, dental extraction (pulling a tooth) is a common procedure in adults and teens. Most often, it is not necessary for you or your teen to use an opioid for the discomfort following the procedure. A cool compress and Tylenol or a NSAID for 24-48 hours is often sufficient.

Before prescribing a prescription painkiller, your physician will take a medical history. It’s important that you provide the requested information, which will help your doctor understand if you have any issues or medical conditions that could increase your risk of side-effects related to opioids. These include:

  • Depression
  • Anxiety
  • History of addiction or alcohol abuse
  • Family history of addiction or alcohol abuse
  • Working in a safety-sensitive position.
  • How your driving will be affected initially, and ongoing

Informed Consent and Treatment Agreements

If you have chronic pain, you healthcare provider should work with you to develop a treatment plan that you agree with and understand. This should include the potential risks and benefits of opioid treatment as well as a clear understanding about your physician’s handling of prescription requests and proper medication use. Your doctor should also outline for you what the expected outcomes of treatment are. Often, pain medications help but can’t make all your pain go away; so, your treatment plan should include coping strategies. 

Your treatment plan may also include goals of treatment, your consent to drug monitoring, consent to conduct pill counts, and your agreement that you will take your medications as prescribed.

The following is some of the important information that your healthcare provider should provide before you start treatment for chronic pain:

  • Potential risks and anticipated benefits of chronic opioid therapy.
  • Potential side effects of the medication, such as constipation and mental impairment. 
  • The likelihood that tolerance to and physical dependence on the medication will develop.
  • The risk of interactions with other medications, especially those used for treating depression and anxiety.
  • The risk of impaired motor skills that could affect your driving and other tasks.
  • The impact of the combination of benzodiazepines (such as Xanax and Valium) and opioids on breathing and the risk of overdose, and overdose resulting in death.
  • The risk of opioid misuse, dependence, addiction and overdose.
  • The limited medical evidence as to the benefit of long-term opioid therapy and some mention that in some people opioids can actually increase pain over time.

In addition, your physician should explain her prescribing policies and expectations, including the number and frequency of prescription refills, as well as his policy on early refills, replacement of lost or stolen medications, and specific reasons for which your opioid therapy may be changed or discontinued.

Your treatment agreement should also outline the joint responsibilities of you and your physician, including:

  • Your responsibility for safe medication use, such as not using more medication than prescribed or not using the opioid in combination with alcohol or other substances; storing medications in a secure location; and safe disposal of any unused medication.
  • Your responsibility to obtain your prescribed opioids from only one physician or practice.
  • Your agreement to periodic drug testing (blood, urine, hair or saliva).
  • Your doctors’s responsibility to be available or to have a covering provider available to care for unforeseen problems and to prescribe scheduled refills.

If you and your physician have a relationship marked by mutual trust and a strong therapeutic alliance, you will be better able to candidly discuss all chronic pain treatment options as well as your concerns. This will allow you and your doctor to develop the most appropriate and effective treatment plan designed for your individual needs.

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