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Medications for Pain: Opiates

June 9th, 2014 · No Comments

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?

Opiate medication, sometimes called narcotics 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, you’re probably better off if your medication regimen for chronic pain looks 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
While narcotics are great for acute pain, they often don’t work so well for chronic pain, especially nerve pain. The negative side effects can be greater than the good effects, making them not worth taking.

2. Tolerance
Over time, your body gets used to their effect. So to get the same benefit, a higher and higher dose is needed. Unfortunately, the side effects continue to increase too. 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 most bothersome ones are usually sedation, slowed 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 or are greater than the side effects. When narcotics are used, it’s important to see if a person’s functioning is also improved, in addition to a decrease in pain.


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