If appropriate your physician may consider opioid therapy in your treatment plan.
Opioids can be a life changing medication for many patients with chronic pain, if used responsibly. Opioids have great potential to ease pain; however they have equal potential for deadly side effects and misuse.
Opioids, also referred to as narcotics, are pain relieving medications that come from the opium poppy plant. Natural opioids include codeine and morphine.
Opioids work by binding to opioid receptors in the central and peripheral nervous system were they produce analgesic effects by decreasing the perception of pain, decreasing your reaction to pain, and increasing pain tolerance. They do not have an effect on the source of the pain, such as anti-inflammatory medications due by reducing the inflammation that causes pain.
Opioids also bind to other opioid receptors throughout the body producing unwanted side effects such as GI constipation, respiratory depression, and sedation. They also often produce euphoria which is one of the reasons why they can also lead to abuse, misuse and addiction.
Safety is always a big concern when using opioids therapy. Opioids should only be used as prescribed. You should report any side effects to your doctor especially sedation or respiratory depression. Your doctor may recommend that you not drive or operate heavy machinery among other limitations while on opioids therapy. Opioid therapy can also cause cognitive impairment as well thus these medications may not be a viable option for many in the management of their pain.
Two other important conditions associated with opioid medications not often found in other pain medications include dependence and tolerance.
Opioid dependence is a normal physiologic response that occurs with continued use of opioid medications. This is often manifested by withdrawal symptoms if the medication is stopped or reduced abruptly. Opioid dependence can be addressed and withdrawal prevented by gradually tapering off the opioid medication, if the decisions made to no longer use opioid therapy as part of the treatment plan.
Opioid tolerance is also the body’s normal response to continued use of the opioid medication. It results in a reduction of the drugs effect over time requiring an increase in medication to achieve the same level of pain relief. Tolerance often develops sooner for respiratory depression and sedation than for analgesia (pain relief), however tolerance to the constipating effects of the opioids never occurs and patients often have to take daily stool softeners.
Some strategies used by pain specialist to overcome or address these issues include drug holidays as well as opioid rotations. The idea of drug holidays is to slowly titrate off your opioid medication and be off opioid medications for a few weeks to months, allowing the opioid receptor to “reset themselves”, thus making the medication more effective once they are restarted. The concept behind opioid rotation is to exchange one opioid medication for another. Due to the slight variation between the opioid medications, incomplete cross-tolerance between opioids and intra-individual variations in response, opioid rotation allows one to achieve a better balance between analgesia and side-effects.
Also your doctor will consider adding adjuvant pain medications such as antidepressants and anticonvulsants which can increase the effects of the opioids. These adjuvant medications are often referred to as opioid sparing in the fact that by adding these medications to the treatment plan one may require less opioids to get the same pain relief. This may decrease the problems of dependence and tolerance or at least prolong their development.
Often more worrisome than dependence and tolerance is opioid addiction. A common myth is that everyone who uses long term opioid medications will eventually develop opioid addiction, which is false. This misconception often is due to lack of understanding of the definition of addiction. Addiction is a chronic disease characterized by persistent drug-seeking and drug-taking behaviors despite the negative consequences associated with it. Drug addiction includes physical as well as psychological dependence. Unlike pure opioid tolerance and dependence (which are normal physiological responses) opioid addiction is a disease that is not a normal response to opioid use.
Often patient with undertreated pain may develop “addiction like” behaviors, unlike true addition these behaviors are eliminated once the patient receives effective pain treatment. This is referred to as pseudoaddiction, because to the untrained eye it looks like addiction but is rather under treatment of pain.
It is important to know and understand the risk factors to developing addiction when you and your doctor decide if opioid therapy is an appropriate option for your treatment plan. Your doctor will assess you for risk factors and discuss then with you.
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