Chronic pain is one of the biggest health challenges someone can face. Chronic pain is unpleasant in itself and can seriously damage your quality of life. It’s also one of the few things that has been shown to lower your happiness setpoint. In other words, after a period of adjustment, most of us have an equilibrium point we return to, whether we’ve just won the lottery or lost a limb. Chronic pain is one of the few things that makes people less happy in the long term. Chronic pain can also have secondary effects on your quality of life because it can interfere with your sleep, your relationships, and your activity level. People suffering from chronic pain often rely on opioid painkillers to treat their symptoms and are afraid of living with pain if they decide to quit using opioids. However, using opioids to treat chronic pain has some serious drawbacks and it might not even be the best approach. Here’s why.
Opioids are addictive.
Most people are aware by now that opioid painkillers can be addictive. However, many people assume that if you use medication prescribed by a doctor as directed, there is little or no chance of becoming addicted, but that’s not true. Addiction is complicated and people with risk factors such as a family history of substance use, mental health issues, or a history of abuse, trauma, or neglect may become addicted to opioids within a relatively short time. Although most doctors have adopted more conservative prescribing practices in recent years, even responsible prescribing can lead to addiction if you have the right risk factors. Of people with opioid addictions, more than half of women and about a third of men first started taking opioids with a prescription.
The risk is even greater in the case of chronic pain because, unlike being prescribed opioids for a short period following a surgery or injury, using opioids to treat chronic pain is open-ended. That means an essentially ongoing plan to keep taking opioids. Even if you try to keep your dosage low, you will build a tolerance to the drug and need more for it to work. Once you’ve started to build a tolerance, opioids are much harder to quit. Opioid withdrawal symptoms are among the worst of any drug and may include nausea, vomiting, diarrhea, sweating, shaking, fever, runny nose, headache, insomnia, and other symptoms. Fear of withdrawal often keeps people using opioids for years, even when they want to quit.
Opioids carry health risks with long-term use.
Some people have the attitude that even if they are dependent on opioid painkillers, it beats living with chronic pain. This attitude is understandable, since chronic pain is so miserable. However, people who believe this often underestimate the long-term risks of opioid use. As noted above, even with conservative dosing, everyone develops a tolerance to opioids and needs more to get the same pain relief. Unfortunately, your tolerance for the pain-relieving effects far outpaces your tolerance for other physiological effects. That means that as your dosage creeps higher, you get closer to the level at which you might experience life-threatening effects like breathing suppression.
Even if you don’t overdose on opioids, long-term use can have many negative side-effects. One study found that of patients who had been on opioid therapy for more than six months, 75 percent showed symptoms of sleep-disordered breathing, such as sleep apnea — several times the level typically found in the general population.
Other studies have found that long-term opioid therapy significantly increases your risk of heart attack and heart failure. Long-term opioid use may also lead to neurological effects such as dizziness, drowsiness, impaired coordination, and even depression. Long-term opioid use correlates with more emergency room visits and more fractures from accidents. One reason for the increase in fractures may be that hormonal changes caused by long-term opioid use may increase the risk of osteoporosis in women. These hormonal changes can also cause sexual dysfunction, fatigue, infertility, and low testosterone in men. Finally, some opioids have immunosuppressant effects, which may lead to more frequent illnesses.
Opioids can increase pain sensitivity.
Opioids are best used for short-term pain following an injury or medical procedure. The pain from those kinds of things is typically severe at first, but then falls off quickly over the following days. Chronic pain is different. Although it may fluctuate, it stays more or less the same for a long period. The problem is that opioids become less effective as time goes on. As previously noted, you develop a tolerance even when you increase dosage conservatively. Another way to say this is that you become more sensitive to pain. You notice this most when you try to quit. Increasing your pain sensitivity is the opposite of what you want to do. Perversely, there is even a condition called opioid-induced hyperalgesia. This is when opioids cause you to be hypersensitive to pain. Sometimes you become more sensitive to the original pain, and sometimes it’s an entirely new pain.
There are safer, more effective alternatives.
People who are afraid to give up opioids as a means of managing chronic pain are often not aware there are other effective options. If you experience chronic pain, you should see a specialist who is familiar with the full range of options. These may include a number of different, nonaddictive medications, such as NSAIDs and others. Even over-the-counter NSAIDs like ibuprofen can be surprisingly effective and recent research has found that the combination of ibuprofen and acetaminophen is more effective than either alone for treating pain and is comparable or even better than opioids, in addition to being non-addictive. There are also non-pharmacological ways of treating chronic pain. Physical therapy, aerobic exercise, and even psychotherapy have been shown to reduce the severity of chronic pain.
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