Opioids for Chronic Pain Management

Opioids often are the go-to pain killer for everything from back aches and injuries to post-surgical and chronic pain, as evidenced by the more than 300 million prescriptions written each year.

Common prescription opioids include codeine, fentanyl, hydrocodone, oxycodone, oxymorphone and morphine. All have some risks and can be highly addictive; one drug in this category, heroin, is illegal.

You should only use prescription opioids under a physician’s supervision and be prepared to ask questions about the use of opioids.

For more information on how to talk to your physician about opioids and controlling your pain, click here.

Pain Awareness Month

In recognition of Pain Awareness Month in September, the American Society of Anesthesiologists commissioned a nationwide survey in August 2017 to study the relationships that different generations have with pain management methods — including opioids. Download the Opioid Use for Pain Management Across Generations infographic for a glimpse at the results.

How Opioids Work

Opioids prompt the release of dopamine, a brain chemical that reduces the perception of pain. Some people may experience intense pleasure and calm feelings when taking opioids. Taking too many may lead to opioid misuse and abuse.

Safe and Effective Pain Control

Opioids can be part of an effective pain management plan, but they should be used only under a physician’s supervision. If you are prescribed opioids, follow our safety tips:

  • Talk to your physician: Ask how to minimize the risks. If you have taken opioids in the past, tell your physician how they affected you, as well as if you have a history of addiction or if you have any medical conditions. Any of these factors could increase the risk of side effects.
  • Watch out for side effects: Some side effects of opioids may be mild (such as sleepiness and constipation), while others, including shallow breathing, slowed heart rate and loss of consciousness can be serious and may be signs of an overdose. Ask your physician what you should be aware of, and what you can do to prevent potential problems.
  • Take opioids only as directed: Follow your physician’s directions, and read the prescription label. If you take other medications, ask your physician whether it is also safe to take opioids.
  • Prepare for surgery: If you are taking opioids and preparing for surgery, talk with your surgeon, the physician anesthesiologist and other physicians who are treating you. Your medical care team will help you determine how to manage pain before, during and after surgery. Chronic use of opioids increases the risk of complications from surgery and can lengthen your hospital stay.

Ask your physician about pain management alternatives, including:

  • Combination therapy: Opioids may not always fully manage the pain; in fact, only about half of the people taking them say their pain is controlled, according to the Substance Abuse and Mental Health Services Administration. Multimodal therapy (a combination of medications and other methods) can improve pain management and decrease the dose of opioids you may need.
  • Nondrug therapies: Many people find relief with alternative therapies, such as biofeedback (where you learn to control involuntary functions such as heart rate), meditation, massage and acupuncture. You may also get relief with interventional therapies, such as nerve blocks, or surgical procedures in which the nerves causing the pain are cut. A physician anesthesiologist or other pain medicine specialist can help you find what works best for you.

Safe Storage and Prescription Drug Disposal

Always store prescription medication — including opioids — in a safe and secure place. Do not leave prescription bottles in the medicine cabinet, and keep medication away from others, particularly young children. Many drug overdoses occur when children find medications that look like candy and swallow them. Others find prescription drugs in the house and use them inappropriately. Never share your prescriptions; more than half of the people who misuse prescribed opioids got them from a friend or relative, according to the Substance Abuse and Mental Health Services Administration.

If you have leftover or expired prescription medications, follow these drug disposal tips, being sure to remove the prescription label that contains your name and other identifying information:

  • Watch for information about the annual National Prescription Drug Take-Back Day. On that day, take your unwanted or expired prescription drugs to a local collection site approved by the Drug Enforcement Administration (DEA), typically a municipal site such as a police station.
  • Check with your municipal trash and recycling service program providers about approved disposal drop-off options in your community.
  • Some pharmacies and health care clinics provide drop-off boxes, or sell specially designed drug disposal envelopes. Seal and mail the drug disposal envelope to an approved facility.

Be diligent about finding a prescription drug disposal option that adheres to policies set by law enforcement and environmental agencies. If in doubt, follow the U.S. Food and Drug Administration’s guidance for safe prescription drug disposal. As a last resort, you may consider flushing medication down the toilet or mixing the medication with dirt, kitty litter or coffee grounds and throwing it into the garbage.

Opioid Overuse and Addiction

Opioids are highly addictive; they can make your brain and body believe the drug is necessary for survival. As you learn to tolerate the dose you’ve been prescribed, you may find that you need even more medication to relieve the pain — resulting in addiction. More than 2 million Americans abuse opioids, according to the National Institute on Drug Abuse.

Signs of Opioid Overdose

Every day 78 people die from opioid overdoses, according to the Centers for Disease Control and Prevention. Signs of an opioid overdose include:

  • Slow, shallow breathing
  • Extreme sleepiness, inability to talk, or unconsciousness
  • Blue or grayish skin color; dark lips and fingernails
  • Snoring or gurgling sounds

If you suspect an opioid overdose, call 911 for emergency medical care. Learn more about what to do in the case of an opioid overdose.

Naloxone

Available as an injection or nasal spray, naloxone is a lifesaving medication that can reverse the effect of an opioid overdose. Access to naloxone is expanding on a state-by-state basis. Naloxone can be prescribed by a physician, is often carried by police officers and emergency medical responders, and is increasingly available over the counter at some pharmacies.