APM Blog

Opioids’ Place in Pain Management

02 Nov

The issue of prescription drug abuse is making its way into the public spotlight, spurred along by an increasing number of news stories and even its inclusion as an issue in the 2016 presidential race. Opioids are a key part of that discussion, especially since deaths involving prescription opioid overdoses in the U.S. increased 3.4-fold from 2001 to 2014.[1] This staggering statistic, paired with opioids’ increasing presence in public discussion, means it’s now more important than ever to fully understand this powerful drug – and its place in treating chronic pain. What is an Opioid? According to the National Institute on Drug Abuse (NIAD), at its core, an opioid is a drug that relieves pain by reducing the intensity of pain signals reaching the brain. They also affect the brain’s limbic system, which controls emotions, effectively diminishing the effects of painful stimuli and producing feelings of pleasure and relaxation.[2][3] Some of the most common prescription drugs in the opioid category include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine, among others. The illicit drug heroin also fits into this class.  Opioids’ Prevalence Combined, the various types of prescription opioids have a major presence in the U.S. Enough opioids were prescribed in 2012 for every adult in the country to have their own bottle. That’s roughly 259 million prescriptions a year.[4] In comparison, there are twice as many painkiller prescriptions per person in the U.S. than there are in Canada.[5] So why are these drugs used so widely? Well, because of the way they work, opioids have been deemed some of the most effective drugs for the relief of pain and suffering.[4] In the short term, these drugs can be particularly effective against acute pain. It’s when these drugs are used past the short term (about 90 days) that the risks associated with them start to stack up. Examining the Risks Every day in this country, 44 people die from prescription opioid overdose.[6] And roughly 1.9 million people live with a substance use disorder involving prescription opioids.[7] While it is by no means a certainty that those who utilize opioids past the 90-day window will experience these same problems, there is still cause for concern. The longer an individual uses opioids, and the higher the dose they’re on, the more chance they have of experiencing life-altering – or even life-threatening – side effects.[8] Additionally, according to prescribing guidelines from the Medical Directors’ Group in Washington, “While there is evidence that opioids can provide significant pain relief in the short term, there is little evidence for sustained improvement in function and pain relief over longer periods of time.”[9] The chronic use of opioids is associated with tolerance, meaning the same dose of opioids will become less and less effective over time. This can set the stage for escalating dosages – and escalating risk factors. Seeking a Solution While there are obvious risks involved in long-term opioid use, it doesn’t change the fact that these drugs provide relief for millions of people with chronic pain. For many, it is the only way they can get out of bed in the morning. The solution, then, must not be just to taper down their opioid usage; it must also be to provide these individuals with other options that effectively work to reduce pain in the long-term. What does this mean for your care? Advanced Pain Management physicians are committed to decreasing patients’ need for opioids by reducing their overall pain levels. They do this by offering interventional procedures – such as injections of pain-relieving medications, the administration of radio waves to ablate painful nerves and even implantable devices that can stop the brain from feeling pain – all to get patients back to a more normal lifestyle, with eliminated or reduced dependence on medication. Pain relief without the haze of medications, without being subject to the clock and a pill bottle, and without the risk of becoming yet another opioid statistic is possible. In fact, it’s just a call away. [1] “Overdose Death Rates.” National Institute on Drug Abuse. 2015. Accessed February 24, 2016. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. [2] Mind Over Matter: The Brain's Response to Opiates. National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2006. [3] "What Are Opioids?" National Institute on Drug Abuse. November 2014. Accessed March 04, 2016. https://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-opioids. [4] Rosenblum, Andrew, Lisa A. Marsch, Herman Joseph, and Russell K. Portenoy. "Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions." Experimental and Clinical Psychopharmacology 16, no. 5 (October 2008): 405-16. [5] "Opioid Painkiller Prescribing." Centers for Disease Control and Prevention. July 2014. Accessed March 04, 2016. http://www.cdc.gov/vitalsigns/opioid-prescribing/. [6] "Prescription Drug Overdose Data." Centers for Disease Control and Prevention. October 16, 2015. Accessed March 07, 2016. http://www.cdc.gov/drugoverdose/data/overdose.html. [7] Hedde, Sarra, Joel Kennet, Rachel Lipari, Grace Medley, Peter Tice, Elizabeth A. P. Copello, Larry A. Kroutil. “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration (2014). [8] Bohnert, Amy S. B. "Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths." Jama 305, no. 13 (April 06, 2011): 1315. [9] Interagency Guideline on Prescribing Opioids for Pain. Washington: Agency Medical Directors' Group, 2015.

Last modified on Wednesday, 22 November 2017 08:31

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