If your pain is chronic and severe, your doctor may prescribe opioids — the heavy-duty narcotics that include morphine (Kadian, Avinza), oxycodone (OxyContin, Percodan, Percocet) and codeine, among others. These drugs are the strongest pain relievers and the most reliable. They work by attaching to opioid receptors, blocking the perception of pain. They can also be addictive.
Unfortunately, these painkillers are also controversial. Some doctors avoid prescribing them because of the rise in substance abuse and prosecutions of doctors who prescribe the drugs. Because these drugs can be habit-forming, some patients are afraid that they will become hooked. But only a small subgroup of people ever get addicted, and there are safe ways to give opioids to people who need them.
The long-term benefits and risks of these drugs are uncertain. Some evidence suggests that opioids can make you more sensitive to pain, and those effects may be long-lasting even after you stop taking the drugs.
The drugs can also affect mood and concentration, and can lead to constipation. Although they have been shown to improve pain scores, they do not seem to improve function. In other words, you might feel better, but still find yourself sitting on the couch rather than getting up and about.
Opioids aren't appropriate for every pain condition. They are extremely effective at managing cancer pain and may be an option for severe arthritis pain, for example. But research suggests that they're of little benefit for full-body pain or bowel pain from conditions like irritable bowel syndrome.
Nor are they helpful when psychological distress is intertwined with the pain. When you look at people with three or more pain complaints, the incidence of psychological stress is 80 to 90 percent. Those patients should not have narcotics.
Get informed. Get the facts and have a discussion with your doctor about your concerns.
You've heard that opioids (narcotics) are habit-forming. And it's unsettling to know that illegal trafficking of these drugs is rising. But some of your fears about the drugs could be unfounded. Let's shake out the facts from the fears.
Addiction is a psychological condition, in which a person craves a drug. Research indicates that only about one percent of pain patients who use opioids become psychologically addicted. However, some people do become physically dependent on the drug and will have withdrawal symptoms, such as restlessness and insomnia if they stop taking it abruptly. As they become more tolerant of its effects, they also need increasing amounts of the drug to get the same pain relief.
They can. Opioids can slow breathing temporarily in patients new to a drug, and pain only exacerbates this effect. Doctors address the problem by starting a patient on the lowest effective dose and continuing to give the patient doses that keep pain at bay.
A British study found that many cancer patients believe the doctor has written them off once he prescribes morphine. They also fear that they will not be able to function once they take the drug. But the fact is that using morphine for pain can improve the quality of the patients' lives, allowing them to function better than they could without it. Its use does not necessarily mean the patient is dying.
