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Opioids for Chronic Pain

Controversial Narcotic Pain Medications

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Updated April 28, 2014

Opioids are powerful pain-relieving substances that are used as analgesics, or pain medications. They come from one of three places -- some are derived from plants, some are manufactured in a lab and others, such as endorphins, occur naturally in the body.

Opioids are very effective in the treatment of severe pain. In fact, they are frequently used to treat acute pain, such as post-surgical pain, as well as severe pain caused by diseases such as cancer. While opioid use for the long-term treatment of chronic pain is still somewhat controversial, these drugs can be effective and safe when taken under close medical supervision.

Types of Opioids

Depending on your needs, you may take one a few types of opioids. Opioids can be formulated as long-acting or short-acting pain medicine. While they may be taken intravenously, most people with chronic pain who take opioids use the pill or patch form of the drug.

Some opioids, such as oxycodone and hydromorphone, are straight narcotics. Others, such as codeine and hydrocodone, may be mixed with other analgesics such as acetaminophen. Another class of opioids, defined as agonist/antagonist, combine medications to decrease pain and to decrease the potential for dependence. These include buprenorphine and butorphanol.

Opioid Side Effects and Other Complications

Many people with chronic pain tolerate the same opioid dosage for years without building up drug tolerance, or without developing physical dependence on the drug. Like most things, the extreme cases are the ones that get all of the negative publicity.

Unfortunately, many chronic pain sufferers who take opioids may wrongly be labeled as addicts, even if they do not meet the actual criteria for addiction. There is sometimes a certain stigma associated with taking narcotic pain medication, which can be frustrating for the person with severe chronic pain.

In addition to tolerance and physical dependence, opioids do have a number of other potential side effects. These may include:

  • Drowsiness
  • Confusion
  • Nausea
  • Constipation
  • Urinary retention
  • Difficulty breathing
  • Sexual dysfunction
  • Low blood pressure
  • Itching sensations

Opioids tend to affect seniors and children more than adults, so these populations must be monitored even more carefully. Often physicians start opioid doses very low and slowly increase them until a therapeutic level is reached.

Certain drugs may interact negatively with opioids, so careful monitoring is required if you also take other prescriptions regularly. Be sure to inform your doctor of any other medications you take, including those purchased over the counter, to avoid potential complications such as a drug overdose.

Why Use Opioids at All?

With so much controversy surrounding their use in chronic pain conditions, you may wonder why doctors prescribe opioids at all. Simply put, opioids are very effective at reducing severe pain. Many people with chronic pain get relief only through opioid use. For these people, the benefits of opioids outweigh the risks. Side effects and potential for dependence do not happen in every case. For many people with chronic pain, opioids can help give them back their quality of life.

Before starting you on opioids, your doctor should perform a full assessment as well as schedule regular consultations to monitor your condition. Some doctors may trial you on opioids, gradually increasing your dose while you are watched for potential complications.

Sources:

American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/14/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

American Pain Society. Advocacy: The Use of Opioids for the Treatment of Chronic Pain. Accessed 6/14/09. http://www.ampainsoc.org/advocacy/opioids.htm

Ballantyne JC, Shin NS. Efficacy of Opioids for Chronic Pain: A Review of the Evidence. Clinical Journal of Pain. 2008 Jul-Aug;24(6):469-78

The Merck Manuals Online Medical Library. Pain: Treatment. Accessed 6/14/09. http://www.merck.com/mmhe/sec06/ch078/ch078d.html

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