brain, spinal cord, and nerve disorders
Treatment of Pain
Opioid Pain Relievers
Opioid pain relievers (analgesics)—sometimes called narcotics—are effective for many different types of pain. Usually, they are the strongest pain relievers. Opioids are chemically related tomorphine, a natural substance extracted from poppies. Some opioids are extracted from other plants, and other opioids are produced in a laboratory. Opioids are often prescribed for a few days to treat severe pain that is likely to lessen quickly (such as pain due to injury or after surgery). Doctors usually switch people to nonopioid pain relievers as soon as possible because opioids may have side effects and there is a risk of misuse or addiction. Opioids are not usually recommended to treat people with chronic pain. Doctors sometimes prescribe opioids for longer periods of time for people who have severe pain due to cancer or a terminal illness, especially as part of care at the end of life, including Hospice Care . In these situations, side effects can usually be prevented or managed, and misuse or addiction is less of a concern. Before prescribing opioids for any type of chronic pain, doctors consider What the usual treatment approach is Whether other treatments could be used Whether the person has a high risk of side effects from an opioid Whether the person is at risk of misuse or abuse of an opioid drug or is likely to use the drugs for other purposes (for example, to sell them) Doctors may refer people to a pain specialist or a mental health care practitioner who has expertise in substance misuse if the risk of having a problem is high. For example, people who have had an addiction usually need such a referral. When opioids are prescribed for chronic pain, doctors explain the nature of the person's disorder (if known) and the risks and benefits of other possible treatments, including nonopioid drugs and no treatment. Doctors ask people about their goals and expectations. They usually give the person written information that describes the risks of taking opioids. After people discuss this information with their doctor and understand it, they are asked to sign an Informed Consent document. When doctors prescribe an opioid for chronic pain, they explain the risks and side effects of opioids. People are advised Not to drink alcohol or take antianxiety drugs or sleep aids when taking the opioid To take the recommended dose at the recommended times and not to change the dose To store the opioid in a safe, secure place Not to share the opioid with anyone To contact their doctor if the drug makes them drowsy or they have any other side effects (such as confusion, constipation, or nausea) To dispose of unused pills as directed To keepnaloxone(an opioid antidote) on hand and to learn and teach family members how to administer it if an opioid overdose occurs If an opioid is prescribed, doctors have usual practices to ensure the person's safety. Doctors typically ask the person to get opioid prescriptions only from one doctor and fill prescriptions at the same pharmacy every time. They see the person frequently for follow-up visits and monitor the use of the drug to make sure it is safe and effective. For example, doctors may periodically test the person's urine to determine whether the drug is being taken correctly. They also ask the person to sign an agreement that specifies conditions required for opioid use, including any monitoring that may be needed. To avoid misuse by others, the person should keep opioids in a safe place and dispose of any unused drugs by returning them to the pharmacy. Opioids have many side effects. Side effects are more likely to occur in people with certain disorders: Overview of Kidney Failure , a The following commonly occur when opioids are used: Drowsiness Mental fuzziness or confusion Nausea and vomiting Constipation Less common side effects of opioids include Retention of urine Involuntary contraction of muscles (called Myoclonus ) Itching A dangerous slowing of breathing Death Drowsinessis a common side effect of opioids. For some people who take opioids, drowsiness disappears or decreases within a few days. If people continue to feel drowsy, a different opioid can be tried because the degree of drowsiness caused by different opioids varies. Before an important event that requires alertness, people may be given a stimulant drug (such asmethylphenidateormodafinil) to offset the drowsiness. For some people, drinking a caffeinated beverage helps offset the drowsiness. When feeling drowsy after taking an opioid, people should avoid driving and take extra care to prevent falls and accidents. Confusioncan also result from taking opioids, especially if people are older. Opioids increase the risk of falls in older people. Nauseasometimes occurs in people with pain, and opioids can increase the nausea. Antiemetic drugs taken by mouth, suppository, or injection help prevent or relieve nausea. Some commonly used antiemetic drugs aremetoclopramide,hydroxyzine, andprochlorperazine. Theitchingcaused by taking opioids may be relieved by an antihistamine such asdiphenhydramine, taken by mouth or given intravenously. Constipation in Adults None Urinary Retention None For most people, nausea and itching disappear or decrease within a few days. But constipation and retention of urine usually decrease much more slowly, if at all. Serious side effectscan occur when people take too much of an opioid. These side effects include a dangerous slowing of breathing (respiratory depression), coma, and even death. The following adds to the risk of developing respiratory depression and of dying from respiratory arrest: Having certain conditions (such as liver, kidney, respiratory, or mental health disorders) Having a Substance Use Disorders None Taking other drugs that cause drowsiness (such as benzodiazepines) Drinking alcohol Some of these side effects can be reversed withnaloxone, an antidote usually given intravenously or sprayed into the nose. For people who are at increased risk of opioid side effects (including respiratory depression), doctors may prescribenaloxonewhen they prescribe the opioid. Nurses and family members or caregivers should watch for serious side effects of opioids and, if such side effects occur, be ready to injectnaloxoneor spray it into the person's nose. Doctors or pharmacists usually teach the person taking the opioid and family members or caregivers how to administernaloxone. Tolerance None Long-term effects None Physical dependence is not the same as Substance Use Disorders (addiction). Dependence is characterized by a craving for the drug and compulsive, uncontrolled use of the drug despite the harm done to the user or other people. Most people who take opioids to control pain and have not previously had problems with drug abuse do not become addicted to opioids. Nonetheless, doctors regularly monitor people who are taking opioid analgesics for signs of addiction. When possible, opioids are taken by mouth ( Oral route ). When opioids are taken by mouth, the dose and time they are taken can be adjusted more easily. When they need to be taken for a long time, they may be given by mouth or through a patch placed on the skin ( Some people who need to take opioids for a long time and are helped by an opioid taken by mouth cannot tolerate its side effects. For these people, an opioid can be injected directly into the space around the spinal cord through a pump ( Injection routes ). Opioids are now the leading cause of accidental death and fatal drug overdose in the United States. Problems with using opioids include opioid misuse, diversion, and abuse. Opioid misusemay be intentional or unintentional. It includes any use that differs from what is prescribed. Diversioninvolves selling or giving a prescribed drug to others. Abuserefers to recreational use of the drug. That is, the drugs are taken for the feelings of pleasure or sensations they produce, rather than to treat pain or another medical condition. Up to one third of people taking opioids for a long time to treat chronic pain misuse them. Substance Use Disorders None 