If over-the-counter drugs don't deliver enough pain relief, your doctor may prescribe an opioida narcotic. Opioids are either refined from the opium poppy plant, or have been artificially created to work in the same way. The most well known is the very powerful drug morphine.
Opioids can drastically lower pain messages being sent by the body to the brain, and then calm the brain's reaction to themwhich in turn helps a patient deal better with the pain emotionally. Our bodies produce opioids naturally; we call them endorphins, and they are often associated with pleasurable things like a runner's high or sexual bliss.
Addicts seek narcotics for a variety of benefits, including a high, although many patients do not experience this effect. Chronic pain patients are generally looking for another kind of relief.
Opioids only help with pain, not its cause
But it's important to remember that opioids only suppress pain. "Opioids don't work on the source of the pain like NSAIDswhich can reduce inflammationdo," says Jeffrey Goldstein, MD, director of the Spine Service at New York University's Hospital for Joint Diseases. "Instead they just mask the pain and help you deal with it."
Unlike NSAIDs, there is no ceiling dose at which opioids stop working. Users can become tolerant and require more for the same effect. (Among addicts, this can lead to phenomenal intake as tolerance builds and the high becomes more elusive.)
Opioids do have side effects
Even when not abused, opioids do have side effects including:
- Respiratory depression (slowed rate of breathing, one of the more serious concerns)
- Dry mouth
- Difficulty urinating
Since side effects can differ from drug to drug, doctors may rotate patients through different medications.
A "tightwire balancing act" on narcotics
When contractor Nicholas Severais, 58, of San Mateo, Calif., fell off a roof several years ago and broke one of his vertebrae, he was put on a whole slew of opioids during the course of his treatment. They alleviated the pain but brought other challenges.
"I got nightmares and hallucinations from the morphine. And with that, and the codeine, I also got long-term constipation," he remembers.
Severais ate fruit and took mild laxatives but found he was constantly worried about how many painkillers he'd taken and how many laxatives he needed to counteract them.
"Your whole life becomes this kind of tightwire balancing act between 'How many painkillers did I take today?' and 'Should I or shouldn't I take one of these?' You get into these patterns where you're taking all these pills to counteract the pills that you are already taking."
Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University, says that although constipation will be a problem as long as you're on the medication (the drug slows down your gut), other side effects do seem to diminish with time.
"The sedation, or sleepiness, usually gets better as people are on the medication longer, as does the nausea. But some people just can't stay on it, because they can't take being sedated or nauseated for two or three weeks."
Aside from oral dosages, opioids can be taken many ways, including by rectal suppository, intravenous injection, under-skin implantation, skin patch, or even injection into a region around the spinal cord. Some opioids give relief for just a few hours, though controlled-release formulations, such as that found in OxyContin, can provide pain relief for much longer. (A fentanyl patch can give pain relief for up to 72 hours.)
Though these drugs can bring great relief to chronic pain patients, scandals surrounding them have led to the prosecution of doctors who prescribe them inappropriately. And that can make it more difficult for legitimate pain patients who need the relief of opioids to get access to them.