Pain Management And Opioids

WHAT YOU SHOULD KNOW:

• An opioid medicine treats pain. An opioid may also be called a narcotic. Another word for any kind of pain medicine is analgesic. Sometimes people do not want to take opioids, but opioid use is approved by many medical groups and experts. Opioid medicines often work well to decrease or relieve pain. Hydrocodone is the opioid medicine that is used most often to treat pain. Morphine is used most often for cancer pain. Some other opioid medicines are codeine, hydromorphone, oxycodone, oxymorphone, buprenorphine, pentazocine, fentanyl, meperidine, propoxyphene, methadone, and tramadol. Opioids may be combined with other medicines, such as acetaminophen or aspirin.
  
  
• Opioids may be used to treat acute (short-term) or chronic (long-term) pain. Chronic pain is pain that lasts longer than three months. After being treated for pain, your mood and sleep may improve. It might be easier to walk and do the activities that are part of daily life. Pain management might also decrease how often you need to see caregivers.

AFTER YOU LEAVE:

Tell your caregiver about all of the medicines that you take:

• Give your caregiver a list of all your medicines, including over-the-counter medicines, vitamins, and herbal products: These medicines may make your opioid stronger or weaker, or have an unexpected effect. Tell your doctor if you are using any other medicines that make you sleepy or tired. These include sleeping pills, cold and allergy medicine, and sedatives. Opioid medicine can also make you tired. It could be dangerous to take both together.
  
  
• Other medicines: Other medicines can be used with the opioid medicine to decrease pain. This may include medicine that is also used to treat depression or seizures (convulsions).

Taking opioids:

Learn the correct way to take your medicine (the route). Depending on the opioid medicine that you need, it may be taken in one or more of the following ways:

• Swallowed, as a tablet, capsule, or liquid.
  
  
• Injected into a vein (intravenous or IV).
  
  
• Injected through a shot just under your skin.
  
  
• Injected into a vein through a pump (patient-controlled analgesia or PCA).
  
  
• Injected into the space around your spinal cord (epidural).
  
  
• As a patch that you place on your skin (transdermal).
  
  
• Dissolved slowly in your mouth, as a lozenge or a tablet (sublingual or buccal). Your medicine may be on a stick, similar to a lollypop.
  
  
• In a suppository, which is put into your rectum.

Short-acting or long-acting opioid medicine:

The length of time that opioids work to decrease your pain varies. Some opioids work for 3 hours, while others can work for up to 72 hours. Ask your caregiver if the opioid that you are using is short-acting or long-acting.

• Short-acting: Short-acting opioids begin to work faster, and their effects go away sooner. Short-acting medicines are often used for acute pain or pain that comes and goes. Short-acting opioids are also used for breakthrough pain. Most short-acting opioid medicines relieve pain for about 3 to 6 hours. Breakthrough pain is sudden pain that flares up in people who have chronic pain. The chronic pain is usually under control. Breakthrough pain is the on and off episodes of pain that may occur even if you are taking pain medicines.
  
  
• Long-acting: Long-acting opioid medicines usually last 8 hours or more, so you can take them less often. These medicines take longer to start relieving pain. Long-acting opioids work to relieve pain for a longer time, and stay in your body longer. Long-acting opioids are used for pain that is constant. Long-acting opioids may be called extended-release, sustained-release, or controlled-release. They are often used for around-the-clock pain control.

Keep opioid medicine in a safe place:

Opioid medicines is dangerous for children. One form of medicine looks like a lollypop, which a child may want to eat. Keep all of your medicine away from children. Keep your opioid medicine in a locked cabinet to prevent others from using it.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

• Your doctor may want you to come in for regular check-ups. During these visits, your doctor will ask you how the medicine is working to relieve your pain. He will ask you about side effects, and talk with you to learn if changes to your treatment plan are needed. He will also ask you about your use of the medicine to check if you are using it correctly. Your doctor may want to test a sample of your urine. A urine test can check for drug abuse or addiction, and can be used to learn if your treatment is working as it should.
  
  

Side effects of using opioids for pain management:

Common side effects include the following:

• Constipation (having hard stools that are difficult to pass), nausea (feeling sick to your stomach), or vomiting (throwing up).
  
  
• Dizziness, light-headedness, or sleepiness. While taking opioids, avoid driving, using machines, or anything else that could be dangerous if you are not alert.
  
  
• Dry mouth.
  
  
• Trouble breathing, breathing too slowly, or your breathing stops. This is called respiratory depression. If you already have a lung disease, such as chronic obstructive pulmonary disease, your risk of respiratory depression is greater.
  
  
• Trouble thinking, moving slower than normal, clumsiness.

Less common side effects include the following:

• Increased pain.
  
  
• Hormone changes. Hormones are special chemicals made by your body that help it work normally. The amounts of hormones, such as estrogen or testosterone, could get higher or lower. This can affect a woman's monthly period, and cause mood and sexual drive changes in both men and women.
  
  
• Problems with your immune system. Your immune system may not work as well as it should. You may get more infections than you would if you did not use opioids.
  
  
• Sleep problems such as sleep apnea may occur after using opioids for a long time. Sleep apnea is when you stop breathing for periods of time while asleep.
  
  
• Sexual problems can occur after using opioids for a long time. You may have trouble having sex, or lose interest in sex.

Some side effects may go away after you have been taking the medicine for awhile. If side effects worsen, your caregiver may suggest that you take less of the medicine or that the medicine be changed. He may also change the way that you take the medicine (the route), such as changing from pills to a skin patch. You may need to take other types of medicine to decrease side effects, such as nausea or constipation. Constipation can be treated with laxative or stool softener medicine. Caregivers may also suggest that you drink more liquids and include more fiber in your diet. Ask caregivers for more information about how to decrease constipation if this is a problem for you.

Signs and symptoms of an overdose:

Taking too much of an opioid medicine can be dangerous. The following are signs of an overdose:

• Fatigue (sleepiness).
  
  
• Dizziness or weakness.
  
  
• Difficulty breathing, shallow breathing, or breathing slower than normal.
  
  
• Cold or clammy skin.
  
  
• Severe (very bad) muscle pain or weakness.
  
  
• Confusion.
  
  
• Seeing or hearing things that are not real.

Risks of using opioids for pain management:

• Physical dependence: Dependence means your body needs the medicine in order to work properly. If you are physically dependent, you will have withdrawal symptoms, such as shaking, diarrhea (loose watery stools), and a runny nose, if the medicine is stopped.
  
  
• Tolerance: Tolerance means that your body gets used to the medicine. The opioid might not control your pain as well as it used to. The pain may come back sooner. You might need more of the opioid medicine to give you the same amount of pain relief.
  
  
• Addiction and abuse: Addiction means continuing to use an opioid even though it harms you and does not relieve the pain. People who are addicted crave the medicine and cannot control how much they use. Addiction usually does not happen when people are using an opioid for true pain control. Addiction and abuse are more likely to happen if you or someone in your family already has a drug or alcohol problem, or if you have used illegal drugs in the past. If you have abused alcohol or drugs in the past, you may need to work with an addiction specialist while being treated with opioid medicine. This caregiver can help you manage the use of opioids to relieve your pain.

Pregnancy and breastfeeding:

Do not use an opioid medicine if you are pregnant or breastfeeding, unless your doctor says it is okay. If you have severe pain that stops you from doing the things that you must do, your caregiver may suggest that you keep using the opioid. You and your unborn baby will need special care if you use an opioid medicine while pregnant or breastfeeding.

Do not drink alcohol while you are taking an opioid:

Drinking alcohol (liquor, mixed drinks, beer, wine) while using opioids is dangerous. Both alcohol and opioids cause sleepiness, and can make you breathe more slowly, or make you stop breathing. Drinking alcohol and using opioids can make you fall into a deep sleep, and be unable to be woken up (coma).

Other ways to manage pain:

Talk to your caregiver about the following:

• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
  
  
• Biofeedback training: Biofeedback is a special way to control how your body reacts to things like stress or pain. The first step in this training is to use electrodes (wires) to monitor your body responses. These electrodes are placed on different parts of your body, such as your chest. The electrodes are attached to a TV-type monitor which gives a paper tracing of your heart beating. You will learn how to control body changes, such as slowing your heart rate, when you become upset.
  
  
• Counseling and cognitive-behavioral therapy: Counseling, or talk therapy, is when you talk to a caregiver about how you are feeling. Cognitive-behavior therapy involves talking to a caregiver about things that may cause or increase your pain.
  
  
• Heat wraps or cold packs: Hot or cold packs placed on painful body areas may decrease the pain. Ask your caregiver about using hot or cold therapy safely. Massage (rubbing) body areas may also help relieve chronic pain.
  
  
• Rest and relaxation: You may need to get more rest. Ask you caregiver for more information about rest, relaxation, and stress management.

CONTACT A CAREGIVER IF:

• You keep having pain, or you have new pain.
  
  
• You have new symptoms or your symptoms get worse.
  
  
• You cannot do your usual activities because of side effects from the opioid.
  
  
• You have constipation that will not go away.
  
  
• You have other side effects that you cannot tolerate.

SEEK CARE IMMEDIATELY IF:

• You are very sleepy and cannot stay awake.
  
  
• You are too dizzy or weak to stand up.
  
  
• You have trouble breathing, shallow breathing, or are breathing slower than normal.
  
  
• Your skin is cold and clammy.
  
  
• You have severe muscle pain or weakness.
  
  
• You are very confused.
  
  
• You see or hear things that are not real.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.