Medications For Pain Series: Narcotic or Opiate Medication

November 26th, 2007 · 12 Comments

Today is the deadline for submissions to November’s Pain-Blog Carnival, which will run this Friday, November 30. Please submit your post here.

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This article is one in a series on Medications for Pain… What are your choices? How do various medications work? What are the pros and cons? How about side effects? (Discuss these ideas with your doctor. Don’t make any changes to your treatment by yourself.)

Today we’ll look at the medication category of Narcotics, also called Opiate Medication. 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 should look something like this:

If used, 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 one’s 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. The balance of good effects versus problems may not be so favorable in 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 or 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, 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. Only 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 they initially decrease 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. We need to be sure that for any patient, the benefits are worth the risks. When narcotics are used, it’s important to see if a person’s functioning is improved, in addition to a decrease in pain.

I’ll be interested in reading your thoughts about narcotics in the comments…

Thanks to Not Walton at Flickr for the first photo.

Next Monday, we’ll look at Upcoming Advances in Pain Medication. Other articles in this series:

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Tags: Site News · medical · medication · treatment

12 responses so far ↓

Nickie // Nov 26, 2007 at 8:15 am

I have used opioids as part of my treatment plan. Because of all of the hype surrounding them, I was really quite scared to even try them. I think they can be helpful, but for me, it’s taking a while to figure out the correct dose. We know they help me, we just have to find the correct med and dose.

I’ve also been fortunate to not experience a lot of side effects.
How to Cope with Pain // Nov 26, 2007 at 9:54 am

Thanks, Nickie for your comment. Like Nickie says, for many medications it takes a while to find the right dosage. Keep working on it!
Christy // Nov 26, 2007 at 10:36 pm

Unfortunately, I look a lot more like the first pie chart than the second. Initially, that was not the case, but the only medicine that seems to make any difference is Vicodin (well, the Duragesic patches helped, but I wanted out of that). Part of it may have to do with the fact that I’ve had 9 knee surgeries so it’s a good medicine to have immediately after a surgery, but I’ve been taking it on a daily basis since 2003.

I have no poor side effects and after taking it for so long, I can function like any normal person while on it, but the stigma that comes with it certainly sucks.
How to Cope with Pain // Nov 27, 2007 at 6:35 am

If it works and you have no significant side effects, then it’s good for you. Besides pain relief, it’s important to look at if it helps you function, ,which you say is the case. Good for you!
Many patients comment about the stigma, which is unfortunate that it comes along with a class of medication that sometimes really helps patients.
jeisea // Dec 1, 2007 at 6:58 pm

I really appreciate this article as it clears up a few things for me. I took Tramel (Tramadol maybe in the US). I felt fantastic (young even) for about 6 hours. However I very quickly developed a tollerance and within weeks of first taking it my body withdrew form the drug with resultant shaking, vomiting etc for over 30 hours. In the end I felt worse than before I took the drug. I appreciate learning the difference between tollerance and addiction.

I can not take pain meds now and consider that this is a blessing as I’ve been able to find real pain and symptom relief without the use of medications and the hell that can go with taking them. I encourage others to empower themselves by learning from websites such as yours and make informed decisions about treatment.
How to Cope with Pain // Dec 1, 2007 at 7:52 pm

Yes, big difference between tolerance and addiction.
Glad to hear this website helps a bit! Thanks.
bad druggy // Dec 21, 2007 at 12:34 am

How does Jeisea cope with her pain without medicine. I have osteo arthrties in the neck. I tried the NSAI but help little. Dr gave me an Endyral patch, Morphine, Oxycontin, Methadone, and thougth hey help the pain ,the side effects are making me misarable. I am trying Oxyconting again. Does anybody there know if the side effects get better with time? I got Reglan for nausea and constipation, but what can I do about the itching and headache, and gummy groggy, tired feeling, I can’t even concentrate to read a book.
How to Cope with Pain // Dec 21, 2007 at 5:26 am

You’re right… while opiates can help, they often do have significant side effects. Sometimes these side effects do lessen a bit as your body gets used to the pain.

You might look over other posts about non-medication ways to help with pain. (You can use the search feature above to help with that.)
jeisea // Dec 21, 2007 at 8:46 pm

Hi BD
Hope you don’t mind my answering your question, “How does Jeisea cope with her pain without medicine?”

The truth is I sometimes cope with great difficulty. The reason I can’t take medications is because I get dangerous cardiac reactions to most meds. A Vascular Physician/Cardiologist advised me never to take them, including paracetamol. This is due to dysautonia affecting my blood pressure. I had no choice but to look for alternative ways of coping and now realize that not taking medications has been a blessing.

At first I was devastated and frightened. Faced with sink or swim, I decided to swim. I began by changing my attitude from what can be done to help me to what can I do for myself. Then I hit the internet. I looked up research. When I didn’t understand I sent emails to the researchers, and all those contacted have helped me. I wrote down what helped, eg heat packs, etc. Hooshmand’s website helped me with practical “do-able” stuff like epson salts baths.

I discovered something Dr Lorimer Moseley had written about mirror therapy. It sounded feasible to me so I keep seeking information and research. This was about July last year. I asked my physiotherapist for help. He didn’t know anything about Moseley at the time. Also at this time, I came to the decision that the hands-on physical therapy I was having was making me have more pain. Also at the time I had been given many diagnoses of inflammation problems, eg tendonitis in many areas. I was on a downhill run.

My new physical therapist knew about CRPS/RSD. She taught me to do whole body therapy at home. She taught me how to calm the sympathetic nervous system by activating the parasympathetic system. This reduced pain. She gave me some control. In August last year my old physio saw me in the street very excited about DR Mosely and mirror therapy. He gave me the book “Explain Pain”. I went home and worked out what I thought might work and tried using a mirror to retrain the brain.

This is the single most effective help in pain relief I have found. However I had so much pain and all over my body that I could only do a bit at a time and an area at a time. It’s taken very hard work doing both physical therapy and mirror therapy, and more recently laser acupuncture to get me to the stage today where I am looking forward to a joyful, much less painful, Xmas. Last Xmas was very hard for me. Now I am grateful for no medications. Mirror therapy and acupuncture provided the most pain relief, but exercising yourself every day is a very important part of retraining the brain. Changing the way I feel about my pain and putting a positive spin on whatever life throws at me is how I cope.

I hope all who read this have a blissful, joyful season. Thank you HTCwP for helping us all so very much this year.
Jeisea
How to Cope with Pain // Dec 22, 2007 at 6:58 am

Thanks, Jeisea, for your wonderful answer! I know from Jeisea that it’s a lot of work to be in the driver’s seat of helping yourself with pain treatment. And it’s a process - don’t expect yourself to get there overnight. Thanks for sharing, Jeisea!
bad druggy // Dec 25, 2007 at 5:25 pm

I want to thank How to Cope with Pain and Jeisea for their helpful information on pain. My problem with pain has led to a problem of chronic insomnia. Pain and insomnia have led to chronic depression. When I visit my doctor, he loads me up with medications, but never tries to get to the root of the problem. But I can not tolerate the stuff, especially the opiods. I’ve tried, but all I can do is take it for one or two days, and then I have to stop. Your thoughtful advise, has given me hope, and I have decided to seek other non-chemical methods of therapy to amiloreate my pain. Thanks so much. BD
How to Cope with Pain // Dec 27, 2007 at 3:51 pm

I’m glad you’re seeking non-medication ways to help with pain. And you might try a pain management specialist to see if medical/medication ways might bring you some relief, as well. Often, it’s the combo that works best!