This article is in our series on Medications for Pain… What are your choices? How do various medications work? What are the pros and cons? How about side effects?
Today we’ll look at the medication category of Opiate Medication, sometimes called “narcotics”. These are medications designed to treat both acute and chronic pain.
Of all medications for pain, narcotics probably get the most press and cause the most controversy. If you judged how important or effective narcotics were based on how much is written about them, you’d assume they were the primary treatment for pain:
Blue = Narcotics, Red = Everything else
Instead, your pain medication regimen for chronic pain should look something like this:
If used for chronic pain, narcotics should be 1 medication in an array of helpful treatments.
Narcotics:
Narcotics include opium derivatives (Morphine and Codeine) and synthetic opiates (Methadone, Demerol, Oxycodone).
Effect of Narcotics:
Narcotics work at opioid receptors, where they interfere and stop the transmission of pain messages to the brain. They also alter your psychological reaction to pain. Patients sometimes report still being aware of pain, but not having such an aversion to the feeling.
Side Effects:
- sedation
- nausea or vomiting
- constipation
- breathing difficulty at higher dosages
Issues with Narcotics…
1. Effectiveness
Unfortunately, while narcotics are great for acute pain, they often don’t work so well for chronic pain, especially nerve pain. Sometimes the problematic side effects outway the good effects when they’re used for chronic pain.
2. Tolerance
When narcotics are used, over time your body gets used to their effect. So to get the same effect, often a higher and higher dose is needed. Often as the dosage is increased to continue to get a benefit, the side effects continue to increase. However, don’t mistake tolerance, which is simply a physical process, with addiction.
3. Addiction
True addiction is a disease in which people continue to use a substance (alcohol, street drugs or prescription drugs), despite bad consequences such as physical illness, relationship problems or inability to function at work. Just because your body is tolerant to a medication, it doesn’t mean you’re addicted. Addiction is a behavior; tolerance is a physical process.
However, a small percentage of patients who use narcotics will develop true addiction, with symptoms such as lying about how much medication they’re using, doctor shopping to get more prescriptions, obtaining narcotics illegally, and using the medication to get high rather than to control pain. About 5% of patients who are prescribed narcotics for chronic pain develop addiction. The risk is higher in people who’ve been addicted to drugs or alcohol in the past, and for those who have few other coping skills to deal with pain.
4. Side Effects
Side effects of narcotics can be significant. The 2 most bothersome ones are usually sedation and slowness in thinking, and constipation, which can be severe.
5. Do Narcotics Increase Pain?
An under-recognized problem is that for some people, narcotics can set up a process where pain will increase over time, even if the medication initially decreases pain. Narcotics can cause what’s call hyperalgesia, which is an increase in pain sensations. When this occurs, sometimes doctors think the medication isn’t working and increase the narcotic, when in fact the narcotic itself is increasing pain. A vicious cycle can develop. As with all drugs, for narcotics to continue to be prescribed, it should be clear that they’re decreasing pain.
Conclusion… Pain is bad, and sometimes narcotics are helpful and should be used. Doctors and patients need to be sure that the benefits are worth the risks. When narcotics are used, it’s important to see if a person’s functioning is also improved, in addition to a decrease in pain.
I’ll be interested in reading your thoughts about narcotics in the comments…
In this series:
- Medication for Pain Series 2009
- Aspirin, Motrin and NSAIDS
- Anticonvulsants
- Antidepressants
- Anesthetics
- NMDA receptor antagonists (e.g. Ketamine)
- Muscle relaxants
- Blood Pressure Medication
- Narcotics (Opiates)
- Anti-Psychotics
- Medication Advances Coming Soon
- Research Advances
Thanks to Not Walton at Flickr for the first photo.
11 responses so far ↓
Nancy // Nov 2, 2009 at 2:20 pm
This was a very interesting and enlightening post to read. I’ve never been an advocate of drugs, but I could probably easily change my tune if I had to deal with severe pain over a sustained period of time. My first thought is about getting “hooked” as addiction is probably one of my greatest fears. It seems like there are alternatives available. I enjoyed reading your post, and will check back again soon to read more!
~Nancy
Diana // Nov 3, 2009 at 11:23 pm
What an important article! Thank you for sharing all this wonderful information.
Barbara // Nov 9, 2009 at 8:15 am
After 22 years with RSD I have found that narcotics are the only thing that helps at all. I find that long acting does not help reduce the overall pain but fast acting gets me through many rough times
I used them this way. When I move too much my pain increases. I suffer from wind up pain which is when the level of pain increases independly. When I find the pain is increasing and I cannot stop the increase, I use a quick acting narcotic and it seems to stop the winding up of my pain. By putting a cap on the pain, I do not have to withdraw from the situation I am in. I adjust my activity but I do not have to withdraw. This is very important to maintain a life with severe chronic pain
I have developed this treatment plan over many years. It is not standard treatment but it works for me. Don’t be afraid to try different ways to use. Opiates but you m ust have a doctor who will work with you. When I go through a period of less pain, I lower the amount of opiates I use.
How to Cope with Pain // Nov 9, 2009 at 9:53 am
Barbara, thanks for your input. I think 2 of Barbara’s suggestions are especially important:
1. Find a doctor who will work with you.
2. Focus not just on pain relief, but on increasing functioning.
Alan // Nov 20, 2009 at 8:59 pm
In an upset stage of thinking there is room for emotional over reaction.Through this article and your viewers comments I am able to see ways to steer clear of other cons.
Pros being the experience of not feeling chronic nerve and muscle pain.It’s been about a month since the symptoms of a high
threshold tolerance level complicated my stratedgy for control although it has been every bit worth the viscious cycle of pie.-
Wayne // Dec 3, 2009 at 4:18 pm
I’ve had OA for 20 years or more and then developed RA with host of complications about 10 years ago. I’ve had 2 neck (spine) surgery s and 1 low back all with disk replacement and fusion. The back surgery left me with more nerve damage and numbness in my feet and legs than I had before. I got ahead of myself. There was 3 disk replacement and fusion with each op. I know how people look down their noses at you when they find out about the pain meds that you take. But I take the pain meds just like I take my HBP, Prostate, Gerd, HC, and other meds. I don’t like taking any meds, but if I want to live and live a life with a certain amount of quality, I have to take the meds. End of story.
How to Cope with Pain // Dec 3, 2009 at 7:25 pm
Wayne, well said. They help you to live more fully.
Theresa // Dec 17, 2009 at 2:19 pm
Very well said, everyone. Although I don’t wish my RSD pain on anyone..I’d like those who are so quick to pass judgement on us who, not by our own choice, take pain medications, to experience a day in our lives. Many would fold under the lives we must live. We, who suffer from chronic pain are strong people..who don’t give ourselves enough credit..myself included.
Alexandra Lynch // Jan 13, 2010 at 8:01 pm
I’ve discovered that pain control has to be a holistic matter. I need to stretch and do my yoga every morning and every night. I need not to eat the foods that make me feel generally crappy and sore and bring on migraines. I need to practice good sleep hygiene and give myself enough time to sleep, and I have to adjust my activity levels and provide myself enough down time to keep from exhausting my resources. But at the end of it all, that doesn’t fix the dislocated foot bones or the fibromyalgia. There is still, no matter what, a certain quantity of just straight pain, and that is what the opiate is for.
Interestingly, knowing that I can do something about it- that I am on a low enough dose that if necessary I can take a double dose to get on top of bad pain- makes it easier to cope with the bad days. I know they’ll happen, and I know what to do about it, and that feeling of agency helps me hurt less and feel generally more “normal” in general. Medication, whether it’s the opiates or the muscle relaxant I take to shut down dysmenorrhea or the antianxiety drug for dental procedures, is a tool.
How to Cope with Pain // Jan 14, 2010 at 11:54 am
Alexandra, thanks for sharing a smart approach.
Kim // Jan 18, 2010 at 11:59 am
I have been searching for information on hyperalgesia caused by narcotic and this article was just what I wanted.
My husband had emergency spinal surgery 2 years ago to reverse the effects of a spur rubbing on his spinal column causing him to lose his ability to walk and has been on either Percocet and/or Oxycontin (50mg three times a day) since that time. I had read a article about hyperalgesia from being on narcotics but never thought too much about it till my husband could no longer function dispite the pain meds. His pain seemed to just increase regardless of the increase in dosage. He finally said that he didn’t want to go up with his dose any more and continued to sit at this dose for almost a year. He had multitudes of test and treatments to help with the pain buy nothing ever seemed to work. Finally he decided to just stop the meds COLD TURKEY. Dispite 2 weeks of withdrawal, most of which happened in the first week, he came through it very well. He still has residual insomnia but we are working on that.
The point I want to make is that he is PAIN FREE NOW! After stopping the drugs and mearly taking plain Tylenol and Advil now he is functioning at levels even better than before his surgery. He obviously was suffering from this HYERALGESIA.
I just want to get the word out to so many people suffering from the same thing. THESE DRUGS ARE NASTY! The side effects are terrible and it could have very well cost us our marriage. I commend him for being so strong and stopping the way he did but it was far better than the alternatives. Methadone and Subluxone only prolong the inevidable of withdrawal, because dispite these drugs, once you stop them you will go through the same withdrawal symptoms!!
Thanks for this article, it has explained so much of my years of upset and I now have my husband back. We couldn’t be happier. CHEERS!
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