From politics to patient care, opioids make the headlines more than just about any other drug these days. In fact, the U.S. Department of Health and Human Services has declared opioid use an epidemic.
In response, doctors are prescribing fewer opioid painkillers. Patients with intense and chronic pain are sometimes panicking about their future.
The term “opioids” covers everything from natural opiates like heroin to their synthetic prescription cousins like hydrocodone. This may leave you wondering what’s safe, what’s true and what’s not.
Dr. Russell Kinder, a board-certified anesthesiologist and pain medicine doctor serving patients at Adventist Health Portland’s Interventional Pain Clinic, has offered to help us sort through some opioid myths to gain some understanding about what opioids are and aren’t.
Myth 1: Opioids are all bad.
You can thank one-sided and sensational media coverage for this myth. “Headlines about opioid medications are nearly always negative and often highlight topics such as addiction, overdose deaths and increased scrutiny about opioid prescribing,” Dr. Kinder explains.
Doctors and patients are left trying in vain to fight this misperception with facts. “The truth is that the benefits of opioid use for acute pain after an injury or surgery, as well as for end-of-life and chronic cancer pain, are widely accepted by the scientific and medical communities,” says Dr. Kinder.
While the appropriate use of opioids for chronic non-cancer pain is less clear, opioids can still be used safely and effectively when their risks and benefits are carefully evaluated. “Opioids can play an effective and important role as part of a multimodal approach to chronic pain management,” Dr. Kinder says.
Myth 2: If you take opioids long-term or at high doses, you will get addicted.
Fear is a strong motivator. Media coverage of opioids sometimes makes addiction seem like the inevitable outcome of using opioids for pain management.
“I have seen fear of this lead to patients feeling guilty about using a therapy that is otherwise very effective for them,” says Dr. Kinder. Other patients suffer needlessly by refusing opioid pain relief due to fears about addiction.
“The truth is that the vast majority of people who use prescription opioids either short- or long-term are not going to become addicted,” Dr. Kinder explains. “The key is to carefully screen for those at higher risk of addiction and monitor for misuse and opioid use disorders using a whole host of strategies.”
Those strategies include:
- Pill counts
- Urine drug screens
- Frequent office visits with thorough histories and examinations
The key is to remain aware. “If you suspect that you or a loved one may have developed a problem with opioids, including addiction, you should reach out to your primary care provider or an addiction specialist for resources,” Dr. Kinder recommends.
Myth 3: You won’t get addicted to opioids if you take opioids for legitimate purposes or as prescribed.
Holding a legitimate prescription doesn’t give you a free pass from addiction. “This misconception stems from the belief that people who are addicted to opioids somehow start taking the medications with bad intentions,” Dr. Kinder says.
In reality, many people addicted to prescription opioids start with good intentions. “Unfortunately, there are a subset of people who are prone to addiction,” Dr. Kinder explains. “Exposure to opioids without the proper screening, monitoring and guidance can trigger an opioid addiction.”
Myth 4: More opioids equals better chronic pain control.
“In a sense, this statement is true,” Dr. Kinder admits. “As an example, for a person not previously taking opioids, a higher dose of opioids for an acute injury or after a surgery may decrease pain and improve functionality better than a lower dose.”
That leads patients to believe this extends to long-term use of opioids as well. Surprisingly, that’s not the case.
“Interestingly, long-term studies on prescription opioids for chronic pain indicate that higher doses of daily opioids after several months are no more effective than lower doses in terms of pain control, functionality or quality of life,” Dr. Kinder says.
Higher doses also carry higher risk of side effects, addiction and accidental overdose. “When it comes to long-term use of opioids for chronic non-cancer pain, the current state of the science suggests the saying ‘less is more’ may be accurate,” Dr. Kinder says.
Myth 5: Opioids are the best treatment for chronic pain.
With so much attention on opioids, it’s easy to assume they’re the best option for pain relief, even if the risks sound unappealing. “What often gets overlooked are the many great options available for management of chronic pain,” says Dr. Kinder. Those options include both non-medication therapies and non-opioid medications.
Non-drug therapies for chronic pain include:
- Structured physical therapy
- Psychological support
- TENS units
- “Alternative” therapies such as acupuncture and chiropractic care
Non-opioid medication options include
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil)
- Topical prescription and over-the-counter medications
Other interventions include injections like nerve blocks into or around the spine, muscle injections like trigger-point injections, implantable spinal cord electrical stimulator devices and surgical options.
“Overall, it is thought that a multimodal approach (i.e. using multiple different modalities) is the best approach to managing chronic pain,” says Dr. Kinder. Working with a pain specialists like Dr. Kinder helps patients design a pain management plan personalized to their specific needs.
A fearless approach to opioids
By staying honest and aware about your short-term use of opioid pain relief, you can ensure you won’t be another statistic for the media to sensationalize.
If you or someone you love is dealing with chronic pain, talk to your primary care physician about seeing a pain specialist. Established Adventist Health Portland patients can ask their primary care doctor for a referral to the Interventional Pain Clinic.
If you don’t have an Adventist Health primary care physician, call us at (503) 261-6929. We’ll help you find one who fits your needs and location.
Author: LivingWell PDX Blog
Adventist Health is committed to creating a healthier Portland community.