Issue 41.13
When I sit down with patients to discuss their options of how to treat and manage pain, I list the options from least invasive to most invasive. Generally speaking, most patients are not interested in the ends of the spectrum – the least invasive option is to ignore it and hope it goes away, and the most invasive option is surgery. We usually begin with physical therapy and include within that category heat, ice, massage, physical activities which will help to strengthen, stretch, and support the affected area of the body. The next least invasive option is oral pain medications. Although, the further options do include interventional treatments for pain such as corticosteroid injections, radiofrequency ablations, and spinal cord stimulation, it is pain medicines which I wish to address.
For many of my patients, adding another oral medication to their already robust list of daily medicines is not a great option either – but an option nonetheless. There are different types of pain medicines ranging from over-the-counter to prescription strength to controlled substances. When patients have tried the other options for pain medicines and ask me about opioid medicines, this is what I tell them:
First, prescribing opioid medications such as hydrocodone (Lortab, Norco, Vicodin), oxycodone (Percocet, Oxycontin), and morphine is not my favorite thing to do; however, when other options have failed we can usually rely on appropriate doses of an opioid medication to control the pain while waiting for other treatments of physical therapy, injections, and or surgery.
Second, there are many patients who have feelings of guilt and apprehension about using opioid medications to help control their pain. Patient’s need to know that opioid medications such as the ones listed above are FDA approved for the relief of moderate to moderately severe pain. If the medications are used as prescribed and they allow the patient to improve or maintain quality of life, then use of these medicines is warranted. The risk of addiction with opioids is real, but is greatly reduced in patients who are experiencing pain.
Third, opioid medications have side effects and risks. Depending on where the majority of your opioid receptors are located in your body will determine what kind of side effects and how severe they are. The most common side effect is constipation and tolerance to the medication (meaning the longer a medicine is used the less effective it is) followed by drowsiness, respiratory depression, itching, nausea, and addiction. Our bodies generally overcome the majority of side effects except for constipation and tolerance. Stool softeners and laxatives can be used to counteract constipation and changing opioid medication regimens from one type of pill to another for a couple months at a time or going off the medicine for months at a time can slow down the process of tolerance.
As stated above, long term use of opioid medications is not ideal, but when other options are limited these medicines can be the difference in maintaining quality of life. If you suffer from chronic pain and would like to know your options, call Desert Pain Specialists at 216-7000 for a consultation.