When Are Opioids A Good Option?

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When Are Opioids A Good Option?

While the experts here at Holistic Pain want to promote alternatives to opioid medications to treat pain, we do understand that there may be some instances when it is the best solution. We believe that a conservative approach to this type of medication is always the best course of action, however.

Let’s take a look at some of the reasons when considering opioid treatment may be the most advantageous option.

Opioid medications for short-term relief

Due to the potential of developing an opioid addiction when using the medication for an extended period of time, one of the better uses is for short-term pain relief only. Opioid medications can be effective if they are prescribed for individuals who are undergoing surgery or are experiencing isolated pain due to an injury. As soon as the medication begins to be ineffective, however, there is greater risk for the patient. They run the risk of taking more medication for the same effects which can lead to continued use even after the initial pain has subsided.

The best use of this medication for acute pain is to utilize it only during a very short period of time immediately following the illness or injury. Often it is prescribed to be used “as needed” and, if relief is present using other types of pain relievers, the use of the opioid can be avoided altogether.

Of course, for some patients other therapies, treatments, or medications may not have an effect. If this is the case, it is appropriate to talk to your doctor about alternatives such as opioid painkillers. This kind of treatment should be closely monitored by your doctor to prevent overuse, dependence, and addiction and only used with their express approval.

Use of opioid medications for terminal cancers

Painkiller medications may be used effectively for individuals dealing with the effects of a terminal disease, such as cancer, who are in hospice or receiving palliative care. The use of these medications can help with the reduction of pain caused by the disease and its treatments. In spite of science’s best advancements in the treatment of cancer, some forms remain terminal and untreatable. In the instance that a patient is facing a terminal diagnosis, the use of these pain management drugs can be helpful, but they should also be monitored closely.

Not a good choice for chronic pain

However, most importantly, opioid medications remain a poor choice for individuals suffering from the effects of chronic pain. There is some recent research to back up the argument that patients with chronic pain should avoid prolonged opioid use.

In November of 2014, a report published by the medical journal PAIN demonstrated the correlation between prescribed painkillers and mortality rates among chronic pain patients. Researchers made associations between opioid-related overdoses and the increase of prescriptions for these types of medications to chronic pain patients not diagnosed with cancer. The higher risk of mortality was found among patients prescribed opioids for long-term use as opposed to individuals who used them on a short-term basis.

There were a number of factors in these deaths, including a higher risk of poisoning. In fact, long-term opioid users had a four times higher risk of poisoning than individuals without a chronic pain diagnosis.

From Drs. Harald Breivik and Audun Stubhaug from the Department of Pain Management and Research at the University of Oslo:

“Safe and effective treatment of opioid-sensitive pain is possible but continues to be a double-edged sword that is difficult to handle. It requires deep pharmacological knowledge, experience, resources, considerable patience, and mental energy from a group of helpers who are able to take care of the whole bio-psycho-social conundrum of the chronic pain patient.”

The Cleveland Clinic backs up this research with an informative blog post from October of last year. For too long doctors were prescribing opioids to patients without considering the long-term effects in their effort to stem chronic pain. The years since that trend became popular demonstrated that this approach was not only ineffective but also dangerous. Dependence on these painkillers develops very quickly and, without the right support, patients are at a high risk of addiction and death. In fact, between 15,000-18,000 deaths are reported each year related to the overdose of prescription medications. A phenomenon known as “pill mills” became prevalent which helped individuals get access to these drugs even without the care of a physician. Luckily, most states are implementing programs to crack down on these for-profit drug centers.

In truth, opioid medications do not provide adequate pain relief when used long-term due to the body’s ability to process these chemicals and develop a tolerance. Patients using the drugs over long periods of time typically need to increase their dose to get the same relief they felt at the beginning of treatment. They also carry with them a whole host of side effects including addiction.

Opioids should only be an option for acute pain, terminal conditions, or when other therapies simply do not work.

If your use of opioid medications has been approved by your physician, you should develop a plan that can help you safely and effectively use these drugs in order to avoid long term dependence issues. Our partners at PainDoctor offer this 12-step checklist for patients and their care providers to use to help manage their treatment.

Have you used opioid medications to treat short- or long-term pain? What was your experience?

Image by Nadia Hatoum via Flickr

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About the Author:

At Holistic Pain, we have a passion for helping you and those who around you who suffer from pain find relief. Part of that passion extends to education and transparency. In our Holistic Pain blog, we focus on new research studies, along with our own tips, for maintaining and improving your quality of life, even with pain.

12 Comments

  1. Kathy Hastings February 9, 2015 at 10:21 am - Reply

    I disagree with your article regarding long term use for chronic pain. I did not see in the article anything regarding an alternative, other than visiting your site, which I plan on doing. The real issue is, instead of everyone trying to go against one another, why not all work together to ensure a patient has legal choices for treatment? I, as many other chronic pain patients, are left to try to navigate, research, and then have to advocate for ourselves to receive or try different treatments. Quit being so “hell bent” on each industry/market being negative about the other and promoting only one, when there is a better way to serve the people who suffer!

    • Holistic Pain February 10, 2015 at 3:19 pm - Reply

      Hi Kathy — thank you for taking the time to leave a comment here. The discussion on opioids is a difficult one because many patients do find relief with these medications, but as a pharmaceutical drug, they also have many side effects and risks. As an area for research and discussion, we wanted to highlight both of these. This post only covered opioids as a chronic pain treatment, but if you go to our other chronic pain posts on this site, you’ll find discussion on many other treatments for chronic pain: http://holisticpain.com/?s=chronic+pain. As we noted in this post, opioid medications can be a viable and effective chronic pain treatment when used in full consultation with your doctor and after exhausting other options.

      • melissa (Obama Alumni) February 10, 2015 at 7:46 pm - Reply

        The question is when are opiods a good option? I would answer, when medical marijuana isn’t available.

        There is scientific evidence that cannabinoids possess pain relieving properties, and some clinical evidence to support their medical use for patients suffering from painful conditions.

        Cannabis helps you deal with non-stop chronic pain and function better throughout the day, increasing your quality of life

        In addition those who are suffering from chronic pain, may experience greater relief if your doctors add cannabinoids – the main ingredient in cannabis or medical marijuana – to an opiates-only treatment.

  2. melissa (Obama Alumni) February 9, 2015 at 11:34 am - Reply

    I disagree that opioid medications do not provide adequate pain relief when used long-term. I had 2 car accidents and 2 falls over a 15 year period. I suffered from
    the effects of whiplash that caused discs c 4,5,6 herniation, along
    with a fractured foot. I also have osteoporosis. All of these conditions
    have become arthritic and are accompanied with bursitis and tendonitis.
    I have been taking Vicodin 5/325mg. for the past 5 years and it allows
    me to function in my daily activities. I was on 10/500mg. immediately
    following my accidents. I have never taken nor needed more than 3 in a
    24 hr. period. I may be the exception to the rule in this study.

    • Holistic Pain February 10, 2015 at 3:21 pm - Reply

      Hi Melissa — thank you for taking the time to leave a comment here and talking about your condition. We’re glad you found relief from your pain. We definitely agree that there are patients who find effective relief through opioid medications. However, we believe these are most effective when used in full consultation with your doctor as you are doing and after trying other options first.

    • Kathy Hastings February 15, 2015 at 12:10 pm - Reply

      You are not the exception melissa….not one of us asked to have to live this way.

    • Kathy Hastings February 15, 2015 at 12:17 pm - Reply

      See my response above regarding our advocacy group…

  3. Ambria February 9, 2015 at 11:53 am - Reply

    This article about the treatment of chronic pain is VERY flawed. First of all, I’ve taken the same dose since 2006, so you’re saying that the person had to continue to increase isn’t always true. Esp, if the right drug is selected. They have the testing to be able to determine which drug will work best for each individual.

    2nd : yes, opiates can have side effects. But the neurogenic meds actually have WAY more side effects and I have personally seen cymbalta .drive patients into psychosis.

    You speak of opiate ADDICTION AND DEPENDENCE as of they are the same. They are not. An addict is someone using a medication for the purpose of euphoria, not pain. A chronic pain patient doesn’t feel euporhia because we have PAIN that is being targeted, nor do they divert their meds. Our pain meds are to important to us to EVER sell them. Mine are kept locked and only my spouse knows where they are.

    3: when you do these studies about deaths from opiates, how can you be certain the patient died from opiates and not other diseases. Many chronic pain patients have several different ailments, take many medications etc. Are you taking the time to do autopsy and toxicology on EVERY death, or do you find out they have opiates in their system and stop there? You can’t lump all subjects into the same catagory. If you are, you need to go back and learn proper research. Many opiates have less side effects than antibiotics for god sakes, and again, the gabapentins, amitriptyline, cymbalta, tegratol,.topromax, anti seziure meds, etc.

    It’s time to stop making the patients criminals and start holding the right people responsible. The reality is….WE ALL DIE. Allopathic medicine just BANDDAIDING our symptoms, yet never getting to a root cause is perpetuating more and more horrifying disease. Then again, mang of us have a diagnosis where.after so many things have been tried, the options run out. So do you just say ” Well what small amount of knowledge we in our big ass brains, have nothing else to offer you. You’ve now cost the patients THOUSANDS of dollars, then you push them out the door. If they have been willing to try all your gimmicks, the least you can do is reduce their damn pain
    .

    I have worked in medicine since I was 18. I’m also a holistic practitioner and I’m frustrated at allopathic medicine to the point of having ZERO trust in anything they say. BTW, I’m married to a surgeon, and Co own a surgical practice. I’m sick of being made to feel like less of a person. I’m sick of hearing ” well you don’t look sick” just because I try to still look presentable when I go out of the house. I used to be a vibrant, passionate, extremely intelligent, creative, pretty darn awesome woman. Now I’m just a shell of her. I’ve fought this monster since 1999, isn’t that enough???? I do alternative mostly, but I still need my pain meds. I’ve tried to go off completely, I have no quality of life. There would be no date nights with hubby, sex would be taken off table completely (for me anyway) because I have intersiticial cystitis and Pelvic floor dysfucntion. I’m sure if I was a man it would be more of a concern with sex issues, but woman aren’t even supposed to want or enjoy it, so who cares right??!! WRONG. I want my F’ING life back.

    Doctors are scared to death of the DEA, pharmacists are just being jerks because they worry about their license and we are stuck in the middle.

    When and if I decide to end things, I will video my demise and show everyone what was done to me by medicine. And hopefully my husband will have the strength to continue to fight for me even when or if I decide to give up.

    Thank you for your judgements, your incorrect OPINIONS and all the harm you are doing to those of us so desperate for help. May your spouse or child endure this someday so that maybe you’ll have a shred of compassion. No one would watch their child like that and not BEG for drugs. The compassionate docs are always the ones who have been patients themselves, or have a sick loved one. Their 7 hours of chronic pain training is DISGUSTING. No one can learn that kind of thing in 7 hours. This whole thing is crazy. The war on drugs is crazy and ineffective. I know Americans have a very hard time looking at other countries and how thing works for them, but maybe it’s time we put our egos down and did so. Holland being the perfect example. By decriminalization of all drugs, their addiction rate has went down 50% in one year.WHY???? Because instead of imprisoning people and spending their money on that, they set up treatment facilities. No one should be in jail for years for pot…come on. Such a waste of money and a drain on our society. I have a right to decide what I put in my body, and if it kills me, I’M RESPOSIBLE NOT THE PRESCRIBER. Esp if I chose to take more, or drink alcohol, or combine other street drugs with it. The doctors can only monitor us so much.

    Maybe you guys should find someone new to pick on. It’s kinda pathetic, and we have enough stress and agony to deal with. Let us be!!!! We aren’t the damn problem! !!!

    • Holistic Pain February 10, 2015 at 3:47 pm - Reply

      Hi Ambria — thank you for taking the time to leave a comment here and talking about your situation. The discussion on opioids is a difficult one because many patients do find relief with these medications, but as a pharmaceutical drug, they also have side effects and risks. As an area for research and discussion, we wanted to highlight both of these, not to judge anybody in any way.

      We respect your opinion–there is no one treatment for everyone and chronic pain is very complex.

      We believe in attacking pain from many different angles, depending on what works for the patient. That may mean physical therapy, lifestyle changes, support groups, and in some cases, injections and opioids. Again, we appreciate your thoughts and apologize for any offense we caused.

      • melissa (Obama Alumni) February 10, 2015 at 8:50 pm - Reply

        I spent many months in physical therapy. I had 2 or 3 painful epidural injections in my cervical discs as well as trigger point injections in my scapula. I am not overweight and have a very healthy lifestyle growing my own organic vegetables, walking every day and swimming during the summer months. When it is cold or rainy I experience terrible pain because now my injured bones and discs have become arthric. For added benefit I am about to begin yoga classses and start making organic bone broth which is full of calcium, magnesium, phosphorus, silicon, sulphur, collagen and trace minerals -as well as the stuff that builds glucosamine and chondroitin. I’m also beginning to drink tumeric and milk as an anti-inflamatory.

      • Ambria February 14, 2015 at 8:37 am - Reply

        You speak of ” alternatives” but you still haven’t stated WHAT alternatives. I’m a PRACTITIONER for god sakes, do you not think I do every alternative practice I can???? I am a HOLISTIC HEALTH PRACTITIONER. I also have worked in many branches if medicine. Don’t assume people aren’t doing “alternatives”. Some people can’t even get out of bed, yet are expected to go work out?!?! REALLY?? Maybe some feldenkrais or gentle flow yoga, but high impact cardio…no way!! It’s so interesting to me that it’s only CHRONIC PAIN that has doctors mentioning “alternatives”. Go to your PCP for a cold or flu and they still wanna throw antibiotics at you…smh. Healthcare in all forms is ass backwards right now, period!!!!

    • Kathy Hastings February 15, 2015 at 12:16 pm - Reply

      I think you would be a great member of our group:www.facebook.com/groups/APFActionNetworkFlorida and/or visit us on http://www.fightforpaincareactionnetwork.com. Matters not if you are from Florida or not; this is an issue that is spreading across the nation! Anyone else reading this, please feel free to join us if you are interested in advocating for pain patients!

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