Opioids have played a major role in pain management since the days of laudanum, a tincture of about 10 percent opium, and various other ingredients, ranging from citrus juice to gold. While medicine has come far from the days when the poppy plant was praised as magical, and laudanum was sold as a cough suppressant, opium-based medication is still central to our pain management toolkit.
It’s only since the rapid rise in opioid overdose deaths since the 1990s that lawmakers, researchers, and doctors in the United States have had to scramble for alternative solutions and effective pain management tools to phase out opioids and help patients in acute as well as chronic pain. Nevertheless, despite the epidemic, opioids continue to be an effective medicinal tool – if used right. Here are a few things you need to know about opioids and the role they play in modern-day pain management.
Opioids Are Effective Painkillers
It would be untruthful to say that opioids are ineffective painkillers. In addition to its use as a recreational drug, opium was used as an analgesic and an anesthetic. German chemists further isolated the painkilling alkaloids within opium to discover morphine, codeine, and heroin, and since then, many different drugs have been developed and brought to market, including opium-based ones and synthetic opioids like hydrocodone and fentanyl.
These drugs are all classified as opioids by way of how they interact with the brain’s opioid receptors, inducing a release of dopamine and numbing pain signals in the body. For people in acute distress, from sports injuries to gunshot wounds and major physical trauma, nothing numbs pain as quickly or effectively as an opioid.
Opioids continue to be similarly useful for patients with terminal pain, which is both severe and final. The risk of long-term addiction is largely eliminated when a patient doesn’t have enough time to form an addiction, and the priority for most caregivers in such situations is to elevate and maintain a patient’s comfort levels.
Opioids May Not Be Helpful for Chronic Pain
As effective as opioids are in killing immediate and sudden pain, they may not be as effective in the treatment of long-lasting, chronic pain. Chronic pain is defined as discomfort and pain experienced consistently for at least twelve weeks. While many forms of chronic pain derive from a complicated or inflamed injury, chronic pain can also be a matter of nerve damage, circulatory issues, or another condition worsening the pain and slowing healing, such as severe obesity or major depression.
Treating pain and identifying (and relieving) the cause of the chronic pain are the primary objectives for clinics handling chronic pain patients, and while opioids can bring some relief, research suggests that long-term opioid use is counterproductive and may not only bring diminishing returns due to drug tolerance, but it may also in some cases induce hyperalgesia, or the increased perception of pain.
Opioids come in different shapes and sizes, from pills and capsules to IV pouches, syrups, and powder. Here are the most common prescription opioids:
- Oxycodone (Oxycontin)
- Hydrocodone (Vicodin)
- Tramadol (Ryzolt, Ultram)
- Hydromorphone (Dilaudid)
- Buprenorphine (Buprenex)
- Fentanyl (Duragesic, Abstral)
- Oxycodone + Acetaminophen (Xolox, Percocet)
- Oxycodone + Aspirin (Endodan)
- Oxycodone + Ibuprofen (Combunox)
- Hydrocodone + Acetaminophen (Liquicet, Norco, Lortab)
- Hydrocodone + Ibuprofen (Vicoprofen)
In addition to various prescription painkillers, heroin is also a potent opioid, although it is not used medically. Heroin is very rarely prescribed as diamorphine in the United Kingdom, for palliative care, but is largely banned internationally as a very powerful and illegal narcotic drug. A recent trend has seen street heroin cut with various other substances including fentanyl, an extremely potent opioid (up to 100 times stronger than morphine), causing an increase in accidental overdoses. Speaking of which:
Prescription Opioids, Addiction & Overdose
Much of the risk surrounding the use of opioids in pain management is the addiction risk associated with opioids. Because they have a potent effect on neurotransmission and trigger the release of dopamine in high levels, opioids can cause drug dependence and drug-related death. Doctors should and generally do refrain from prescribing opioids if they are not necessary, in order to avoid potentially causing a patient to get hooked on a drug they do not need.
Many addictions also begin through family members discovering and using a surplus of painkillers recreationally, or as a form of self-medication. Many teens understand that opioids have a euphoric effect, and drugs like codeine have become popular as a choice recreational drug.
Young People & Children Are Prescribed Opioids
Opioids are not exclusively prescribed to fully-grown adults or patients with terminal illnesses, but may also be prescribed to children post-surgery, or for managing a serious sports injury. Children are more susceptible to an addiction than grown adults due in part to the vulnerabilities of a growing brain, but they cannot be refused care for serious and traumatic levels of pain.
However, it should be noted that, in both children and adults, many forms of acute and chronic pain can be managed through non-opioid pain management. The issue often isn’t a lack of alternatives, but a matter of cost. Insurance companies are more likely to OK the use of opioid medication than more expensive rehabilitative therapies or long-term non-opioid, non-pharmacological pain management. But if it is within someone’s means to choose a non-opioid path for themselves or their children, it can be the first choice in most cases.
Non-Opioid Alternatives Are Weaker
There are non-opioid pharmacological alternatives, primarily NSAIDs and acetaminophen. Other prescription medication has shown to decrease pain in both cases of acute as well as chronic pain, particularly anticonvulsants and antidepressants.
NSAIDs and acetaminophen can be administered through pills, and intravenously on a timer. However, these are alternatives are weaker. Still, they can be effective in dulling the pain, depending on what the pain is, and why it’s there.
Effective Pain Management Is More Than Medication
Drugs are one thing, but pain can be reduced in a number of different ways, including heat, cold, massages, compression, light exercise, mindfulness, certain distractions, and entertainment. Patients are more likely to feel anxious and in distress when left alone for longer periods of time, and it’s important for both doctors and nurses to practice a good bedside manner with their pain management patients.
A low mood is associated with greater perception of pain, so being happy can go a long way. Of course, pain itself is detrimental to happiness, but there are ways to cheer someone up and, in doing so, alleviate some of their pain.
Opioids Interact with Other Drugs
Doctors and trained nurses would know this, but it’s equally important for any adult or parent with an opioid prescription to know that certain drugs interact with opioids in a bad way. The most common and potentially dangerous one is alcohol, due to how common it can be. Don’t drink and take opioids at the same time – because they similarly depress and affect the respiratory system, the combined use of alcohol (or other depressants, like benzodiazepine) and opioid medication can lead to respiratory failure and death.
Opioids still play a major role in the treatment of pain, in part due to how our healthcare system forces patients to choose the more cost-effective option. However, the better path involves the use of both non-pharmacological therapies and non-opioid medication, depending on the nature of the pain and the circumstances of the patient. Better patient care and communication are vital as well.