Pain Management And Opioids

What is an opioid?

• 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.

How do opioids work?

Opioid medicines stop nerves from sending and receiving feelings of pain. If the pain message does not get to your brain, then you will not feel the pain. Opioid medicines can block pain anywhere in your body. Opioid medicines work differently in each person. An opioid that works well for one person might not be the best choice for another person. The side effects are also different from one person to the next.

When are opioids used for short-term pain?

Opioid medicines can be used for many different types of pain. Opioids may be used for acute (short-term) pain, such as the following:

• Pain that occurs after surgery (post-operative or post-op pain).
  
  
• Pain caused by an injury.
  
  
• Pain caused by herpes zoster (shingles).

When are opioids used for long-term pain?

Opioids may be used for chronic (long-term) pain. Some experts label pain as chronic if it lasts longer than 3 months. Opioid medicines may be used when other medicine, such as acetaminophen or ibuprofen, have not worked to relieve pain. Opioids may also be chosen for use if you cannot take other types of pain medicine. Chronic pain conditions for which opioids may be used include the following:

• Cancer pain, caused by the cancer itself, or by the surgery, chemotherapy, or radiation used to treat the cancer.
  
  
• Chronic noncancer pain. This may include back or neck pain.
  
  
• Pain caused by injuries that may or will never heal, or that heal slowly.
  
  
• Arthritis pain.
  
  
• Nerve, muscle, or bone pain.
  
  
• Diabetic neuropathy, postherpetic neuralgia, or phantom limb pain.
  
  
• Pain that does not get better after other medicines have already been tried.

Why is pain control important?

Pain can affect your physical and emotional health. Pain can cause depression and sleep problems. It can keep you from doing the things that you usually do, or enjoy doing. Pain can make being around family and friends or going to work hard for you. After treatment for your 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.

How can opioids be taken?

Opioid medicines may be taken in 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.

How long do opioids work?

The pain relief from opioids varies. Some opioids work for 3 hours, while others can work for up to 72 hours. Opioid medicines can be divided into two kinds:

• 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.

What kind of opioid do I need?

Your caregiver will help you choose the kind of medicine that is best for you. You might need to try different opioids or different schedules before finding what is best. Long-acting opioids are most often used for chronic pain. Short-acting opioids are most often used for starting treatment and for decreasing acute pain. Your gender, age, diet, disease, and other medicines can affect how long an opioid works. If you have liver or kidney disease the medicine might stay in your body longer. In older adults, the liver and kidneys may not work as well, so medicine may stay in their bodies longer.

What are the risks of using opioids for pain management?

The following are risks that may occur with opioid use:

• 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.
  
  
• 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.

What are the side effects of using opioids for pain management?

Side effects can limit how much medicine you can take. The best treatment is to find the dose that treats the pain and causes the fewest side effects. 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.

What else should I know about the side effects of opioid medicine?

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.

How will I know if the use of opioids in pain management is right for me?

• Planning: To plan your treatment, your caregiver may do a physical examination. He may ask you questions about your illness and your pain. He may ask about your family's and your health history. He may collect blood samples and do other tests. With this information your caregiver can talk to you about your treatment options and he may suggest that you see other caregivers.
  
  
• Trial period: Many people start opioid treatment with a trial period. During this time, caregivers can see how well the medicine is working, and if you have any side effects. Caregivers can also learn which opioid works best and how much medicine you should take. Most people start with a low dose of opioid medicine. Your caregiver will slowly increase the amount of medicine to learn how well it is working and if you have side effects.
  
  
• Treatment plan or agreement: Your caregiver may work with you to develop a treatment plan or agreement. This plan may include how the opioid medicine should be used, and your treatment goals. Information about other treatments and caregivers may be included in the plan. What your caregiver expects from you, and a plan for what will happen if drug abuse is a problem may also be included.
  
  
• Monitoring: You will need to see your caregiver for regular check-ups. During these visits, your caregiver 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 see if you are using it correctly.

What else can I do to help manage my 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.
  
  
• 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).

What else should I know about taking opioids?

• 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.
  
  
• Learn how to take your medicine. Ask your caregiver for information about the opioid medicine. Follow your caregivers directions for taking the medicine. If you do not understand how to use your opioid, ask your caregiver.
  
  
• Keep opioid medicine in a safe place. Opioid medicines are 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.
  
  
• Tell your caregiver about all medicines you take. Give your caregiver a list of all your medicines, including over-the-counter medicines, vitamins, and herbal products. Some of these 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.
  
  
• 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).
  
  
• Tell your caregiver if you have used opioids in the past. Caregivers must know this information as they work with you to develop a treatment plan.
  
  
• Learn about your medicine. Ask your caregiver for more information about the opioid you are taking.

Where can I get more information about opioids?

• American Pain Society
  4700 W. Lake Avenue
  Glenview , IL 60025
  Phone: 1- 847 - 375-4715
  Web Address: http://www.ampainsoc.org
  

• American Chronic Pain Association
  PO Box 850
  Rocklin , CA 95677
  Phone: 1- 800 - 533-3231
  Web Address: http://www.theacpa.org
  

When should I call my caregiver?

After starting to use an opioid, call your 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.

When should I seek immediate help?

After starting to use an opioid, seek care immediately or call 911 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.
  
  
• You have severe muscle pain or weakness.
  
  
• You are very confused.
  
  
• You see or hear things that are not real.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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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.

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