Should you rely on Opioids for MSK pain relief?

Things to consider before relying too much on opioids or pain killers

In the face of an escalating opioid crisis, at least 100 million people with chronic pain aren’t getting the relief they need and are seeking alternatives. More than 30 percent of Americans are living with some form of chronic or severe pain. More people live with chronic pain than cancer, heart disease, and diabetes combined, for a total of between 100 million and 116 million people.

Simultaneously, opioid addiction and overdose rates have skyrocketed, becoming a full-fledged public health emergency. Despite this, one-third of the country is still in pain, and most aren’t getting the relief they need — from opioids or any other form of treatment,

What are Opioids?

Opioids are natural or synthetic (made in laboratories to mimic the properties of natural opioids) chemicals that interact with opioid receptors on the nerve cells in the body and brain and reduce feelings of pain. They are a class of drugs that include prescription pain relievers, synthetic opioids, and heroin.

Prescription opioids are meant to be used to treat acute pain (such as recovering from injury or post-surgery), chronic pain, active-phase cancer treatment, palliative care, and end-of-life care. Many people rely on prescription opioids to help manage their conditions under the care of a physician.

Opioids and the perception of pain in the brain

Both humans and animals have opiate receptors in the brain that act as action sites for opioids that work by binding to specific receptors in the brain, mimicking the effects of pain-relieving chemicals that are produced naturally. These drugs bind to opiate receptors in the brain, spinal cord, and other locations in the body. This blocks the perception of pain. Opiates can cause feelings of well-being, but they can also cause side effects such as nausea, confusion, and drowsiness.

Can they be very addictive?

Opioids are powerful drugs, but they are usually not the best way to treat long-term (chronic) pain, such as arthritis, low back pain, or frequent headaches. If you take opioids for a long time to manage your chronic pain, you may be at risk of addiction.

With the limitations in prescribed opioids for patients with chronic pain, it often resorts back to the 4 C’s:

• Loss of Control: Patients may lose their prescription, self-escalate their dose, run out of the prescribed opioid early, continually call the on-call service, or show up at the emergency room for more medication.
• Compulsive use: Patients exhibit preoccupation with obtaining the opioid as opposed to focusing on obtaining pain relief, and are opposed to trying other pain treatments despite continued severe pain.
• Continued use despite the risk of harm: Patients may recognize that the opioid is causing adverse events and is not helping their pain, but they still want more.
• Craving: If a patient is waking up in the morning and all he or she thinks about is having more opioids, this is worrisome.

Patients want to do more than mask the pain. Opioids reduce the sensation of pain by interrupting pain signals to the brain. It is longer postulated that opioid-induced pain relief and addiction occur as distinct processes in distinct areas of the brain.

Final Words:

Opioids are neither effective nor safe enough to warrant their widespread use. We should begin to think of opioid treatment for chronic pain as the exception rather than the rule. The question of who the best candidates are for chronic opioid therapy is not simple, and not one that has achieved consensus.