Narcotics in the Management of Chronic Pain
Chronic pain is a state of severe, ongoing pain in one or more parts of the body. It can be caused by physical injury, a medical condition like arthritis or may be idiopathic in nature. Narcotic pain medications from the opiate family are one option for treating moderate-to-severe chronic pain.
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Types of Opiates
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Narcotic pain medications include synthetic and semi-synthetic opiates that range in potency from mild to extremely strong. They are available in pill form, liquid suspensions and IV solutions and may be long or short-acting.
Among the least potent of these medications are tramadol, codeine and propoxyphene, which are often used for pain following dental procedures or minor injuries. Opiates of medium potency such as hydrocodone and oxycodone are among the most frequently prescribed, while the potent drugs oxymorphone, morphine and fentanyl are generally reserved for the most severe pain.
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Effectiveness
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Opiates are often viewed as a last resort for severe, treatment-resistant pain. They work by directly affecting portions of the central nervous system responsible for pain perception, and are extremely effective at treating moderate-to-severe pain in most cases. Unfortunately, many chronic pain sufferers don't receive adequate treatment due to a reluctance on the part of doctors to prescribe opiates on a long-term basis for fear of causing addiction.
Conditions for which opiates are often prescribed include cancer pain, arthritis, post-injury pain and endometriosis. Those with chronic pain of undetermined origin are less likely to be treated with opiate medications.
Tolerance and Addiction
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The most serious drawback of narcotic painkillers is the risk of addiction. Users develop a tolerance to the drug, requiring ever-increasing amounts to achieve the desired effects. This often leads to increased dosing and more frequent administration, which can make it very hard to quit.
Opiates cause physical and psychological withdrawal symptoms that increase in severity based on dosage and how long the medication was taken. While some patients have no problem getting off opiates, others find themselves unable to quit without experiencing a significant increase in symptoms.
Despite these risks, most chronic pain sufferers do not become addicts. According to DrugLibrary.org, chronic pain patients react differently to opiate medications than do street addicts and are unlikely to develop the pathologic behaviors seen in addicts.
Side Effects
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In addition to tolerance and addiction, opiates can cause mental and physical side effects that may be severe enough to discontinue treatment. The most common side effect of opiate medications is nausea, though this usually diminishes with time. Opiates can also cause constipation that may be severe enough to require medical treatment in extreme cases. Other common side effects include itching, euphoria, drowsiness, vivid dreams and difficulty urinating.
Warning
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While most side effects associated with opiates aren't serious, certain symptoms can signal a life-threatening reaction. If you experience difficulty breathing, rapid heart rate, throat swelling or an inability to urinate, seek emergency medical treatment immediately.
References
Resources
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