Severe Pain Medication
The Act of Balancing 'Quality of Life' Against The Risk of Long-Term Damage To Your Health
In This Article –
– What Role for Severe Pain Medication?
– The Dangers
– Using Opioids for Back Pain
The Short Answer –
Morphine, Tramadol, Codeine, Fentanyl, Hydrocodone, Benzodiazepine . All names that mean one thing – extreme pain control. But do you know the real effects on your body?
Today it’s common for severe pain medication to be used for everything from end of life comfort to persistent back pain control. While it may be essential for the former, we ask are the risks just too great to prescribe severe pain medication for back pain – no matter how bad it is?
What Role For Severe Pain Medication?
Sometimes a low-level painkiller just isn’t enough and we need much stronger, more powerful painkillers that provide the fastest and most effective pain relief available. At these times it is highly likely you will be prescribed a ‘narcotic opioid’ painkiller such as those above.
Traditionally, ‘these times’ were selectively only when patients were recovering from major surgery and needed a very short-term high strength pain relief or had a terminal illness. When recovering from major surgery, the long-term risks were kept to a minimum because the painkillers were only prescribed for a very short period of time. Equally, with patients suffering from a terminal illness (most commonly cancer), the short-term boost far outweighed any risks because the long-term outlook was simply not relevant.
The Dangers of Taking Severe Pain Medication
Narcotic opioids such as Morphine were never prescribed for lower back pain. This was because the side effects were considered far too substantial. Downsides that included –
Behavioural Issues –
- Morphine is tied with Heroin in the states as the most common reason for death from an overdose
- It is much harder to maintain attention under the effect of a strong opioid.
- Mood Swings. As the drug reaches high and lows of concentration in your system, so you can experience mini-withdrawals leading to often erratic emotional states
- Extreme Tiredness. Due to the fact that opioids effect the Central Nervous System in order to block your pain, it can also make you feel exhausted.
- Dose Tolerance. Typically, use will increase to higher and higher doses of the opioid as the body becomes tolerant of it’s benefits requiring larger amounts to achieve the same therapeutic effect.
Effects on our Mental Health –
- Disturbed Sleep. If you have to rely on strong opioid painkillers you will experience peaks and troughs that in turn will majorly interrupt your normal sleep patterns.
- Even without being addicted to an opioid, it is still very likely that the deterioration in your normal functioning, added to lack of sleep, lack of sexual drive or capability, will all lead to a severe depression.
- Impaired Thought Capacity. Again, the blurring of using an opioid narcotic painkiller can cause your mind to not function clearly, with the result that you may have thoughts that are not logical to the normal mind, but seem correct to the drug-induced mind state.
Effects on Our General Health –
- Vision Problems. In particular with our ability to see certain colours.
- GI Impairment. Opioids can reduce our bodies’ ability to move through in a healthy manner, leading to constipation and very painful urination.
- Lack of sex drive and Impotence. Both your normal level of sexual desire and your ability to get an erection (if you’re a man) are likely to be affected while you are taking a narcotic opioid painkiller like morphine.
Effects That Are Normally Terminal –
- Impaired Respiration. This can be critical as high doses of an opioid (particularly Morphine) can slow your breathing down to the point that it even stops it completely (which of course is fatal)
- Liver Damage. Every drug you take is processed through the liver. In the case of very powerful painkillers, this is likely to kill your liver in the medium to long term.
- Inflammation on the lining of the heart.
Quite a long list I’m sure you’ll agree – and this was always enough to put the average doctor off prescribing them for anything but the most severe (and short term) needs.
As science has developed newer versions of the severe pain medications we have relied on, so their potential uses have extended as some of the nastier side effects have been considerably reduced….
Severe Pain Medication for Back Pain?
However, as science moved on, so newer long-acting ‘controlled release’ versions of the opioids started to become available. The advantage of these controlled release versions of morphine, fentanyl etc is that they cut out the highs and lows that came with the traditional short-acting versions.
The short-acting preparations of the same drugs have to be taken multiple times a day (normally every time the pain comes back) and lead to lack of sleep, mood swings and depression even in the short-term because of the swings of drug concentration within your body.
So what about you and your non-malignant, chronic back pain? Can opioids play a role in relieving your pain?
Well, the simple answer, regardless of data, is that they are now being used more than ever before for ‘non-malignant’ pain such as back pain. Part of the reason is that several clinical trials were conducted with opioids that suggested not only a role in easing pain, but also increasing mobility and therefore frequently aiding rehabilitation.
One such study (‘Transdermal Fentanyl As Treatment For Chronic Low Back Pain’) – used Fentanyl as the opioid and found that transdermal fentanyl made a significant difference not just to the patients’ pain levels, but also their functional disability.
Other trials also started to suggest that it was just possible some of the long-term dangers were slightly overstated. This ‘overstatement’ centred around two factors –
A Reduced Chance of Addiction.
Several large trials were conducted in to the likelihood of addiction to the opioid after it’s use and what they broadly found was that you were unlikely to become psychologically addicted unless you had a predisposition to addiction in your past.
One study of over 12,000 patients found that only 4 patients without a prior addictive history became hooked. This meant that, at least to some extent, likely addicts could be ruled out before a narcotic opioid painkiller was prescribed for them.
Reduced Cognitive Impairment
New research has even cast doubt around the loss of cognitive impairment (memory, concentration and the ability to make reasoned decisions) with narcotic opioids in the long-term.
Indeed, with transdermal Fentanyl which has the lowest side effect profile during prolonged use, this appeared to have very little impairment effect at all, especially given that patients prescribed such a strong drug are normally on a number of other medications too, some of which will undoubtedly have similar side effects.
However, it is still worth noting that the potential for constipation, painful urination and ultimately gastrointestinal motility (lack of bowel movement altogether) was still present in all of the trials carried out.
The Final Word –
Ultimately, the debate will rage on as to how useful opioids are for long-term pain medication. Their short-term use is undeniable, but their list of potentially nasty side effects will always make them more of a risk for the longer you take them.
In the end it will come down to you and your physician. If you have no addictive tendencies and you’ve tried everything else, but your pain is absolutely debilitating, then they certainly have a role.
Transdermal Fentanyl had by far the lowest side effect profile in clinical trials, but this will (and should) always be a decision for you and your doctor.
Perhaps the most important advice we could offer to help relieve your pain is to make sure you try every other option and if it is still too severe, then ensure your doctor regularly monitors you. This means measuring your creatinine clearance (for kidney toxicity), ensuring your bowel movements are clear, that no other drug might be amplifying the side effects and that you are still clear of mind to continue.
Stepping down from an opioid is not hard to do if it’s done through gradual dose reduction. If there is no clear, clinical benefit to being on the opioid in the first place, then you definitely shouldn’t be risking your health.
Regular monitoring of your overall health by your doctor will help spot and avoid any of the nasty downsides before they become too serious and you can always be taken off the drug before the costs start to outweigh the benefits. But it really does need regular independent medical checks to ensure your safety whenever you are on a severe pain medication.
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