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7 Little Known Effects of Long-Term Opioid Therapy

01 Nov

Tolerance, dependence, addiction – some risks of long-term opioid use are well-known and often talked about. But these aren’t the only negative effects that may arise. There are actually a plethora of common side effects and risks brought about by using these medications, and almost all patients taking opioids for chronic pain (96%) will experience at least one such side effect.[1]

So whether you’re currently on a long-term opioid regimen or simply weighing your pain management options, knowing all the risks of prolonged opioid use could save you some significant suffering down the road. Let our list of seven lesser-known opioid risks and side effects help guide your decision.

  1. Gastrointestinal issues. One of the most prevalent side effects of opioid usage is constipation. In fact, studies have shown that 40%-45% of those on opiate therapy suffer from it.[2] But it’s not the only gastrointestinal trouble caused by opioids; it’s only one of the symptoms categorized under the title “opioid-induced bowel dysfunction,” which also includes abdominal cramping, spasm and bloating, among others.[3] But constipation is often considered one of the worst, since it’s often unmanageable with OTC treatments like stool softeners and laxatives. 2 In addition to bowel-related disorders, opioids can also cause nausea in 25% of people.
  2. Sleep-related breathing problems. Abnormal breathing while asleep is a concerning issue for those on opioids, especially those on high doses. In fact, in a small study, 92% of patients on a dose of more than 200 morphine milligram equivalents (MME) a day experienced ataxic or irregular breathing, compared to 61% of people taking less than 200 mg and 5% of people not taking opioids.[4]
  3. Cardiovascular issues. Long-term opioid use, when compared with NSAIDs, has been shown in some studies to pose an increased risk for events such as myocardial infarction and heart failure.[2][5] This is especially true for those taking codeine for more than 180 days.
  4. Hyperalgesia. Opioid-induced hyperalgesia (OIH) is another possible outcome for patients on long-term opioid therapy. In cases of OIH, the patient actually becomes increasingly sensitive to pain. Although it’s not clear how prevalent OIH is, it can certainly cause some unwanted effects, including extreme acute pain after surgery and escalating opioid dosages.[6]
  5. Increased risk of fractures. Opioid use is associated with an increased risk of fractures, especially among the elderly population. The theory behind this is that opioids affect the central nervous system, causing such symptoms as dizziness and reduced alertness. [2][7] This, in turn, can result in falls. Elderly patients taking more than 50 MME a day have recently been found to be at double the risk of fracture among the elderly population, with a yearly fracture rate of 9.95%.[2]
  6. Hormone problems. Chronic opioid therapy can also have an impact on the endocrine system, causing hormone changes in both men and women. For men, this manifests as hypogonadism, which causes a decrease in the production of sex hormones, particularly testosterone, as well as erectile dysfunction, reduced libido, fatigue and even hot flashes.[8] In women, opioids can cause a decrease in the levels of estrogen in the body, in addition to low follicle-stimulating hormone and increased prolactin. Combined, these changes can lead to osteoporosis, inappropriate milk production and light or infrequent periods.[2]
  7. Depression. Patients on opioid therapy for long periods have an increased likelihood of developing depression. In one study, 38% of people on long-term opioids had at least moderate depression. [2][9] Furthermore, other opioid side effects, like intractable constipation, can lead to or worsen depression. [2]

Opioids can be a useful component in the treatment of pain, but they’re not the only option. If you’re experiencing side effects from long-term opioid treatment – or would like to find pain relief without the use of opioids – consider talking to a pain management specialist, who may be able to recommend other treatment options, including minimally invasive procedures.

Download your free opioids and pain in-depth guide

[1] Gregorian, Razmic S., Alexander Gasik, Winghan Jacqueline Kwong, Simon Voeller, and Shane Kavanagh. "Importance of Side Effects in Opioid Treatment: A Trade-Off Analysis With Patients and Physicians." The Journal of Pain 11, no. 11 (November 2010): 1095-108.

[2] Baldini, Angee, Michael Von Korff, and Elizabeth H. B. Lin. "A Review of Potential Adverse Effects of Long-Term Opioid Therapy." The Primary Care Companion For CNS Disorders 14, no. 3 (June 14, 2012).

[3] Panchal, S. J., P. Müller-Schwefe, and J. I. Wurzelmann. "Opioid-induced Bowel Dysfunction: Prevalence, Pathophysiology and Burden." International Journal of Clinical Practice 61, no. 7 (2007): 1181-187.

[4] Walker, James M., Robert J. Farney, Steven M. Rhondeau, Kathleen M. Boyle, Karen S. Valentine, Tom V. Cloward, and Kevin C. Shilling. "Chronic Opioid Use Is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing." Journal of Clinical Sleep Medicine 3, no. 5 (August 2007): 455-61.

[5] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[6] Lee, Marion, Sanford Silverman, Hans Hansen, Vikram Patel, and Laxmaiah Manchikanti. "A Comprehensive Review of Opioid-Induced Hyperalgesia." Pain Physician 14 (2011): 145-61.

[7] Li, L., S. Setoguchi, H. Cabral, and S. Jick. "Opioid Use for Noncancer Pain and Risk of Fracture in Adults: A Nested Case-Control Study Using the General Practice Research Database." American Journal of Epidemiology 178, no. 4 (August 15, 2013): 559-69.

[8] Smith, H. S., and J. A. Elliott. "Opioid-induced Androgen Deficiency (OPIAD)." Pain Physician 15, no. 3 (July 2012): ES145-156.

[9] Sullivan, Mark D., Michael Von Korff, Caleb Banta-Green, Joseph O. Merrill, and Kathleen Saunders. "Problems and Concerns of Patients Receiving Chronic Opioid Therapy for Chronic Non-cancer Pain." Pain 149, no. 2 (May 2010): 345-53.

Last modified on Wednesday, 22 November 2017 08:45

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