No one wants to be in pain. By its definition, pain is uncomfortable and undesirable. Pain may be physical, psychological, or emotional. In medicine, we tend to focus on the physical pain. For this pain, there seems to be a quick fix – opioid pain medications.
A Growing Trend in the U.S.
The amount of pain medications that are prescribed and used in the United States has exploded over the last couple of decades. Opioids are now the most commonly prescribed class of medication in the U.S. It would appear that there has been an epidemic of new pain syndromes. In reality, this is likely more about a change in how pain is treated. Doctors are giving out opioid pain medication much more readily today than they were 10 or 20 years ago. But is this a good thing?
How Effective Are These Pain Medicines?
The efficacy of opioid pain medications in treating acute pain and cancer pain is well established. However, you may be surprised to know that data on the efficacy of opioids for chronic, non-cancer pain is actually lacking. A systematic review of trials of opioids compared to placebo or non-opioid pain medication in chronic back pain actually failed to show a clear benefit on pain scores with the use of opioids.
If these medications are not proven to be effective for treating chronic, non-cancer pain, why are they being prescribed so readily? There has definitely been a paradigm shift in the prescribing habits of physicians. These medications are certainly of benefit in select circumstances. Yet with the marked increase in the amount of opioid prescribing, we also have to be aware of the significant potential for adverse events. These problems can include physical dependence, tolerance, and addiction. Sometimes, these terms are used interchangeably, but they are significantly different. It is important to understand those differences.
Prescription Drug Abuse: Physical Dependence, Tolerance, and Addiction
Physical dependence refers to the body’s physiological dependence on the opioid medication. After chronic use of opioid medication, a person will develop symptoms of withdrawal upon abrupt discontinuation of the drug. Symptoms of physical withdrawal can include abnormal mood, anxiety, fast heart rate, sweating, vomiting, and diarrhea.
Tolerance refers to a state where the amount of medicine that worked previously is no longer effective. The person needs progressively increasing doses of medication to get the same effect. Increasing dosages can then lead to increased side effects as well.
The last and most problematic adverse effect of chronic opioid therapy is addiction. This is a psychological dependence on the medication that leads to many adverse behaviors in order to obtain and use the medication. Addiction can lead to significant adverse effects on the individual person, their family, and the community as a whole. As the rate of opioid dependence in the community increases, so can adverse events, including criminal behavior and drug overdose related deaths. The problem is even greater in Kentucky than much of the United States. According to the CDC, Kentucky has one of the highest rates of prescription opioid sales and drug overdose deaths in the U.S.
What Can Be Done About This?
Should these medications be avoided all together? It is likely that these medications are significantly over-prescribed. However, this does not mean that they shouldn’t be used in the correct circumstances. Physicians need to be aware of the risk for misuse with each individual patient and, therefore, make prescribing choices on an individual basis. As a patient, you can follow these simple rules to decrease your risk of an adverse outcome:
If you or someone you love is currently showing signs of drug abuse, seek help immediately before it’s too late.