Clearing Blog: Opioids For Pain: What You Need to Know

Opioids For Pain: What You Need to Know

The Clearing Team
The Clearing Team

You’ve probably seen the phrase “opioid epidemic” on the news at some point. There’s a good reason why — over the last couple of decades, opioids have become part of millions of people’s lives. In fact, in the United States, about 10.1 million people misused prescription opioids in 2019. Given this, it’s very likely that you or someone you know has been impacted by opioids. This is why it’s so critical that we clear misconceptions about the epidemic and provide relevant and useful information to you. 

For starters, opioids are a type of medication prescribed by doctors to treat pain. These medications have a wide variety of medical applications, and may be prescribed to treat severe pain caused by anything from a wisdom tooth extraction to a severe back injury. 

On the one hand, for some people, opioids can be effective in providing short-term relief for acute pain. But on the other hand, sadly, these medications can also have severe side effects, and can be highly addictive. After all, opioids aren’t designed for long-term use, and they don’t provide a miracle cure for chronic pain.

In other words, opioids are far from a silver-bullet solution for pain relief. To help break barriers, fight misinformation and provide alternative solutions, we think it’s vital to provide education to people who take opioids or who have loved ones that do.

In our 101 guide to opioids for pain, we cover:

  • The history of opioid use in America
  • The definition of opioids and common prescription names
  • How opioids work within our body to relieve pain
  • The difference between acute and chronic pain
  • The pros and cons of opioids for pain
  • An analysis of the opioid epidemic 
  • Alternatives to regular use of pain medications

The history of opioid use in America

We tend to associate prescription opioid use with the sanitized, brown-paper bag experience of other modern conveniences. You get a prescription from your doctor, bring it to the corner store and then per the instructions, swallow a pill out of a bottle that you picked up from the friendly, white lab coat-wearing pharmacist.

The truth is, these drugs have a long and problematic history. Opium arrived in the United States when the country was still a part of the British Empire, and it was widely used to treat wounded soldiers during both the Revolutionary and Civil War. The Brits themselves staged an entire war over bringing opium into China after the Chinese government objected to smuggling the highly addictive substance into their country. 

Believe it or not, the history of opioids dates back farther than that. A sixteenth-century Persian scholar wrote the first book on opium use and abuse in which he recommended using other natural pain relievers that had less severe side effects. Some scholars even theorize that opium use for pain predates ancient Sumerian civilization. For thousands of years, wherever there have been opioids, there has been opioid addiction. 

What are opioids?

Opioids are a class of synthetic and non-synthetic drugs related to an extract from poppy seeds called opium. 

Opioids commonly prescribed for pain relief in the United States include: 

  • Codeine 
  • Fentanyl 
  • Hydrocodone 
  • Methadone 
  • Morphine 
  • Oxycodone

How do opioids work?

If you’re wondering why opioids are so addictive, the short answer is because they change the way that your body perceives pain. They do this by binding to opioid receptor cells in your body and blocking the pain messages that are ordinarily sent through your spinal cord to your brain. In other words, opioids put you in a state of numbness to make your symptoms more bearable. This dulls the pain sensation while still allowing you to feel most other feelings. 

What’s more, being in this state also relaxes your body and can produce the feeling of euphoria. Opioids stimulate your brain’s reward center, which means that your body comes to associate taking opioids with feeling relaxed and pain-free. Over time, these associates become cravings and can ultimately result in a chemical dependence on the drug. Since the drugs only provide this feeling temporarily, many pain sufferers will go back time and time again to feel better. And sadly, this means they will also have to increase their dosage to replicate the pain-free feeling. Thus, an addiction is born.  

“Opioids produce rapid pain relief, and are therefore suitable for short-term pain relief such as when managing pain after an acute injury or postoperatively,” says Dr. Jacob Hascalovici, MD, PhD, co-founder and Chief Medical Officer at Clearing, and a neurologist and interventional pain specialist at Montefiore Medical Center in New York. 

When you’re taking opioids for acute pain, like after surgery, you will typically be able to recover and stop taking the drugs once your prescription runs out. When you do not need pain relief, your body isn’t sending out the signal for you to reach for the pill bottle to make it stop. 

The real dangers of opioid use lie in using these medications to treat ongoing pain conditions, also known as chronic pain. 

What is the difference between acute and chronic pain?

Acute pain is short-term pain with a distinct cause that comes from a specific place; typically the pain does not last for more than a few months. Some examples include: pain caused by broken bones, labor and childbirth, surgical recovery and dental work.

On the other hand, when you have chronic pain, pain signals will continue to be active in your nervous system even after an initial injury has outwardly healed. “Chronic pain refers to the experience of pain for an amount of time that would exceed the typical, expected healing period after most acute injuries,” Dr. Hascalovici explains. 

Causes of chronic pain may include back and neck injuries, sciatica, arthritis, fibromyalgia and neuropathy. Unfortunately, many people live with these symptoms for extended periods of their life. In fact, as of 2016, the Centers for Disease Prevention and Control (CDC) estimated that 20.4 percent of U.S. adults were living with chronic pain. 

Chronic pain can limit your mobility, significantly decrease your productivity and impact your mental health. It can start to feel like it’s the biggest thing that’s going on and like it’s never going to end. Up to 85 percent of people who live with chronic pain also live with severe depression. 

This feeling of hopelessness or helplessness is sometimes exacerbated by the frustrating experience of getting a diagnosis for your chronic pain. “I see many patients spend months to years either ignoring the symptoms hoping they will self resolve, or doctor-shopping in search for a correct diagnosis,” Dr. Hascalovici notes. 

This is unfortunate because earlier interventions for chronic pain often lead to better outcomes. The longer it takes to receive a diagnosis, the longer it takes to manage the pain.

To complicate things further, sometimes the first line of treatment prescribed for chronic pain is a powerful opioid painkiller. If you have been seeking relief from your pain for a long time, or if your pain is so severe that painkillers seem like the only way to get your life back, taking these drugs for chronic pain might make sense to you at first. But over the long term, using opioids for chronic pain can do more harm than good. 

The pros and cons of opioids for pain

Using strong opioid painkillers to treat chronic pain may work to provide some pain relief. And, well, that’s about the only benefit of using them. Even then, the pain relief is temporary. Once the effects of an opioid wear off, your pain will return. That’s because opioids only treat pain as a symptom — they cannot address the root cause of pain.

The list of cons for taking opioid painkillers for chronic pain is far longer. 

When you first start taking opioids for pain, you’ll notice some of the initial side effects. These may include: 

  • Sluggish metabolism and/or constipation 
  • Drowsiness or fatigue
  • Slow, ineffective breathing, which is also known as respiratory depression
  • Loss of appetite
  • You may also notice a temporary feeling of euphoria or relaxation as the opioid takes effect  

When you use the medication long-term, side effects are more severe. In addition to the short-term side effects, long-term opioid use can result in: 

  • Drug tolerance, leading to increased dosages, to feel the same impact 
  • Reproductive difficulties 
  • Loss of sex drive 
  • Chemical dependence

Medication side effects aren’t the only thing you risk when you take opioids over a long period. While your body’s dependence on the drugs increases, it’s possible that your pain might come back or get worse. 

And last — but potentially, most dangerously — when you decide to stop taking opioids, it’s not as simple as deciding you’re done. These medications cause chemical dependence. Quitting them means putting your body into a state of withdrawal. 

Withdrawal will need to be monitored by a medical professional to make sure that your body is handling it safely. It typically starts within 24 hours of your last opioid dose, and the symptoms mimic the flu. And while withdrawal affects everyone differently, typical symptoms include:

  • Diarrhea
  • Muscle cramps
  • Vomiting
  • Sweating
  • Fever

It can take seven to ten days for these symptoms to go away as the opioids clear out of your system. In the worst-case scenario, it’s possible to overdose on prescription opioid medication accidentally. Mixing other medications with opioids or taking an extra dose of your prescription (on purpose or by accident) increases the overdose risk. People with reduced kidney function and people over the age of 65 are also at a higher risk of overdose.

What is the opioid epidemic?

According to the CDC, 450,000 people died from opioid overdoses between 1999 and 2018. What’s more, overdose deaths from prescription opioid medication were five times higher in 2016 than in 1999. 

The Department of Health and Human Services (HHS) states that 10.1 million people in the US misused prescription opioids within the past year. These sobering statistics are just the tip of the iceberg of what’s become known in the United States as the “opioid crisis” or the “opioid epidemic.” 

It’s hard to nail down a single reason why the use and abuse of prescription painkillers became so prevalent in the late 1990s. Like most historical events, this health crisis was triggered by several factors that seemed to collide all at once. 

Experts mostly agree that sometime in the late 1990s, the pharmaceutical companies manufacturing these drugs made it a point to reassure doctors and the public that modern formulas of opioids weren’t all that addictive, and therefore weren’t all that dangerous. At the same time, the FDA took a relaxed approach to opioid regulation, allowing this mentality to go unchecked within the medical community. 

There was also a movement within the medical community to focus on pain as the “fifth vital sign.” Doctors wanted to bring more awareness to pain as a symptom that could be treated. Unfortunately, this massive push to get attention to pain did not coincide with a wide array of acceptable, alternative long-term treatments for pain. Opioids quite literally became the drug of choice. 

Of course, most doctors who prescribed opioids in the 1990s did not have ill intentions toward their patients. Even now, most doctors who prescribe these medications believe they are fulfilling their oath to “do no harm” to those they treat. If a person complains of pain, a good doctor wants to offer a solution that will bring them relief. It just so happens that pain is exceptionally subjective, and conditions that cause chronic pain can’t be treated with pain relief medication alone. 

For these reasons, government agencies are now directing their energies to massive reeducation campaigns for the medical community and for the general public, among other strategies. The FDA lists “cutting the rate of new opioid addictions” as one of their highest priorities, and guidelines for prescribing opioid medications are becoming far more strict. According to the CDC guidelines, opioids are simply no longer indicated as first-line therapy for any type of long-term pain management.

SUMMARY

Over the last two decades, the opioid epidemic has continued to plague society. According to the CDC, overdose deaths from prescription opioids were five times higher in 2016 than in 1999.

What are alternatives to regular use of pain medications?

The good news is that if you live with chronic pain and are curious about alternatives to opioids, you have more options than ever. We live in an exciting time of innovation and creative thinking when it comes to pain relief. This article is designed to arm you with everything you need to know to make empowered, informed choices about your personal pain relief.

When the opioid crisis came to the public’s attention, it became clear that innovation in the field of chronic pain treatment was desperately needed. There are so many alternatives to opioids for pain relief, and the list is growing longer every day. Here are just a few: 

  • Multidisciplinary clinics combine a team of healthcare professionals working together to provide long-term pain management solutions. You’ll find physical and occupational therapists, nutritionists, neurologists, and nurses at interdisciplinary pain clinics. 
  • Cannabis and its derivatives, including CBD, are becoming extremely popular in the chronic pain treatment space. New legislation that allows cannabis to be prescribed for chronic pain has led the way into a host of innovations that blend the botanical elements of cannabis with other proven pain relievers.
  • Acupuncture, massage therapy, and chiropractic therapy are treatments administered by professionals who practice alternative medicine. The wider medical community is coming around to the idea that these treatments really can help people who experience chronic pain. A growing body of evidence demonstrated by clinical trials supports the use of these treatments.
  • Cognitive-behavioral therapy (CBT) was originally developed to treat depression and anxiety. One of the basic tenets of CBT for chronic pain is that your brain can be trained to change its interpretation of the events that happen to you, including pain. A mental health professional can help you establish coping mechanisms and a feeling of control over your pain, which may actually decrease your pain’s direct influence on your life.
  • Outpatient physical therapy has become a popular option for rehabilitating old injuries or building strength in weak muscles to manage chronic pain. 
  • Topical pain relief creams absorbed by your skin can be highly effective at treating back and neck pain, joint pain, muscle tension and pain from nerve irritation or damage. The best types of pain relief creams combine clinically proven, prescription-strength active ingredients with soothing botanicals to treat chronic pain. 

The Clearing alternative 

There was a time when opioids were widely prescribed to treat any type of pain. But now we know that modern opioids are highly addictive and have severe side effects. 

What’s more, opioids only treat the symptoms of pain. These medications can’t provide a long-term solution or treat the cause of chronic pain. If you live with chronic pain, you have more treatment options than ever before. Safe, holistic, whole-body treatment that manages your pain and gives you your life back is possible. 

At Clearing, we work closely with you to customize a treatment plan to bring you relief from your chronic pain condition. Our personalized, comprehensive treatment plans combine non-opioid medications, personalized exercises and stretches and high-touch care from a team of specialized providers delivered to you in the comfort of your own home via our telehealth platform. If you are interested in learning more and starting a free trial, please click the button below.

This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.