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Chronic pain patients caught in the middle of opioid debate

Opioid painkillers are a blessing for those experiencing severe pain from surgery, trauma, burns, acute conditions and cancer. But for those with chronic pain, long-term opioid use can lead to increased tolerance to the drug and result in adverse health effects. America consumes 80 percent of the world’s opioids, says the American Society of Interventional Pain Physicians.

The adverse effects of opioids and the controversy surrounding their overprescription can leave chronic pain patients stuck in the middle and unsure about what to do.

Long-term effects of opioids

The biggest problem with treating chronic pain with opioids is that these drugs only work for a limited amount of time. After this, the user develops tolerance to the drug, requiring progressively higher doses to achieve the same effect. Eventually, the body becomes chemically dependent on the drugs and higher doses are required merely to prevent withdrawal symptoms, also called dope sickness. At this stage of addiction, pain management is difficult and overdose is quite common.

In addition to overdose, long-term opioid use can adversely affect various organ systems. Constipation, intestinal obstruction, respiratory problem, hormonal changes, anxiety, depression, fractures and sleep disorders are some of the common problems. While the quality of life may improve initially, it tends to decrease as tolerance increases. Opioid addiction can lead to depression, anxiety, social isolation, unemployment and suicide. In addition, many prescription painkillers contain acetaminophen, which is toxic to the liver.

Mixed messages are creating problems for patients

Another problem that patients with chronic pain encounter is the mixed messages they receive from the medical community. Some prescribers use opioids as first-line of treatment for chronic pain, while others use it as a last resort. Some prescribers decide to stop refilling prescriptions when patients show signs of tolerance or addiction, even though these are expected on using opioids for chronic pain. Patients whose prescribers discontinue their medication describe feeling terrified that they will have no option to manage their pain or withdrawal symptoms.

Texas police officer Nick Selby has seen many lives being destroyed due to opioid addiction. Therefore, when he ruptured a disc in his back and required surgery, he weaned himself off the painkillers as quickly as possible. When the pain returned, he was referred to a pain management clinic. As part of The Washington Post-Kaiser Family Foundation survey on long-term opioid users, Selby, who was given an opioid painkiller, shared his experiences of living with pain.

At the clinic, when he asked for alternatives, he was informed that nothing was available. Selby explained “My first pain management doctor was terse as she prescribed more hydrocodone for daytime and oxycodone for the night, when my pain was worse…A nearby chain pharmacy refused to fill it, saying, ‘You can’t mix hydrocodone and oxycodone…’ When I called the pain clinic for help, the staff berated me for bothering them. They asked whether I was seeking drugs. I was –the ones they had prescribed.”

Selby also indicated that the insurance companies added to the problem. They paid for his expensive narcotics but only funded eight physical therapy sessions. He asked for buprenorphine, an opioid combined with naloxone that does not have euphoric effects. But he discovered that his insurance would not include that drug.

Last year, the Centers for Disease Control and Prevention (CDC) published guidelines for prescribing of opioids. The guidelines aimed at curbing unnecessary prescribing, drug trafficking and addiction. They urged doctors to exercise caution when prescribing opioids. Still, the long-term use of opioid painkillers remains controversial.

Seeking treatment for addiction

Sovereign Health is a leader in treating addiction, mental illness and co-occurring disorders through our many specialized programs, including our pain program. The program helps people whose pain has pushed them toward painkiller and/or illegal drug addiction, live healthier lives. Our experienced and compassionate treatment teams provide comprehensive care and ongoing recovery management to help improve physical and mental health. To find out more about our programs, call our 24/7 helpline.

About the author

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. Sovereign Health is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at news@sovhealth.com.

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