Tylenol just not cutting it for your chronic pain? You may need something stronger.
March 20, 2012
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Pain med problems
Opioid drugs such as OxyContin and Vicodin are among the most effective pain medications, but the likelihood of abuse and addiction has discouraged some doctors from prescribing them.
Pain doctors are starting to come around to prescribing opioids, says Roger Chou, MD, associate professor of medicine at Oregon Health & Science University, in Portland. “If somebody’s at low risk [for addiction or abuse], opioids can be a reasonable option for chronic pain,” he says.
Today these medications are more readily prescribed, but they’re hardly risk-free. If you decide to take them, be on the lookout for these potential side effects.
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The high-profile scandals and celebrity rehab stints associated with opioids can be misleading. In reality, the risk of getting hooked on your pain medication is low.
That said, a history of substance abuse or addictionwhether it involved prescription drugs, illegal drugs, or even alcoholis a good predictor that you might be at a higher risk than most, says Dr. Chou.
It’s hard to quantify your risk, he adds, but the most telltale signs are personal or family history, he says.
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While unusual, slowed breathing (also known as respiratory depression) can be among the most adverse reactions to opioids. This happens because of the way pain meds operate on the respiratory centers in the brain stem.
“The body’s regulation of breathing gets blunted, basically,” says Dr. Chou.
Overdose can also cause respiratory depression. This makes it crucial to start patients on low doses and raise the dosage gradually, Dr. Chou says.
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Cognitive changes can occur in people taking opioids because of the way the drugs work on the central nervous system. “You feel less sharp, you think a little bit slower,” says Dr. Chou. “It kind of slows your coordination.”
As with drowsiness, another potential side effect, feeling a bit foggy-headed is usually related to starting a drug or upping a dose.
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Almost everyone who takes these drugs will experience some degree of constipation. That’s because the drugs work on pain receptors that seem to also affect the gut, says Dr. Chou.
Dr. Chou encourages his patients to be proactive about digestive trouble by using a laxative or stool softener as soon as they begin an opioid regimen.
Unlike other opioid side effects, constipation doesn’t tend to go away, unfortunately, so he also recommends products like milk of magnesia as needed.
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Anywhere from 20% to 60% of pain patients will experience a small increase in sleepiness when taking opioid meds.
That’s why people in certain professions, like bus drivers or pilots, are subject to special regulations and laws for prescription drug use.
Drowsiness is most common just after you begin to take the drugs or increase the dose. “It’s the starting period and these adjustment periods where people have to be real careful,” says Dr. Chou. Any drowsiness will usually fade away as you become used to the medication.
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Between 2% and 10% of opioid users may find themselves itching all over. This might seem like an allergic reaction, but allergies to opioids are rare, says Dr. Chou.
The widespread itchiness (known as pruritus) is due to a completely different reason, and it’s bothersome but not dangerous.
This side effect is most common when morphine is administered via an injection into the spine, so experts believe spinal opioid receptors are at work.
If lowering the dose of your pain meds doesn’t cure it, try an antihistamine, like Benadryl.
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About 25% of patients using opioids will experience some nausea, according to a 2003 study.
Opioid-related stomach trouble may be caused by the same mechanisms that lead to constipation.
Unlike constipation, however, nausea tends to fade over time as patients get used to the drugs, says Dr. Chou.
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An overdose can happen if patients increase their dosage over time as they develop a tolerance to the medication.
Over days or weeks, the pain medicine accumulates in the body and can cause slowed breathing, low heartbeat, dizziness, and seizures.
Still, in some cases, taking a higher dose of pain medication than prescribed just once can lead to these side effects.
“Overdose is a big concern,” says Dr. Chou. “People are dying because of recreational use of prescription opioids. That tells us, as physicians, we need to be doing a better job…and stop the medications when they don’t work.”
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Sexual side effects
Living with chronic pain often takes a toll on your sex life. Opioidsand not the pain itselfmay be at least partly to blame, recent research suggests.
The drugs appear to lower testosterone levels, and cause erectile dysfunction in men and difficulty with orgasm for both sexes.
Dr. Chou says more research is needed to fully understand these changes, but in the meantime, pain patients should discuss with their doctors ways they can revive their sex lives.
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