DEAR MAYO CLINIC: If opioids are such a problem in our country, why are they used so often to treat pain? Aren’t there other effective options for controlling pain that aren’t as risky?
ANSWER: Pain is a common medical problem, and opioids are often used to combat it because they can be very effective at relieving pain for a short period of time. However, you are correct that taking opioids poses significant risks, including addiction and overdose. Alternatives to opioids are available, and it’s wise for people who need pain relief to seriously consider using non-opioid options when possible.
Opioids are powerful painkillers. Commonly prescribed opioid medications include oxycodone, morphine, hydromorphone, oxymorphone, hydrocodone, fentanyl, meperidine, codeine and methadone.
These medications are often used in hospitals to combat pain after surgery or to ease pain after a traumatic injury. Opioids also can be the most effective treatment for severe ongoing pain, such as pain caused by cancer. But other uses of opioids are increasing, too. Estimates are that 50 million Americans suffer from chronic pain. Many turn to opioid painkillers for relief. Opioid prescriptions for chronic noncancer pain have doubled in the last decade.
In cases of serious cancer pain, the likelihood of becoming addicted to opioids over time is low. In many other situations, however, addiction to and overdose of opioids is a very real concern. Overdosing on opioids triggers low blood pressure, a slow rate of breathing and the potential for breathing to stop, as well as the possibility of a coma. Opioid overdose has a significant risk of death. In fact, according to the Centers for Disease Control and Prevention, more people in the U.S. have fatal overdoses related to opioid use than compared to overdoses of heroin and cocaine combined.
In addition to these risks, using opioids for more than a short period of time needs to be viewed with caution because little evidence is available to support its effectiveness over time for noncancer pain. People with chronic pain who take opioids typically need higher doses over time to achieve the same level of pain control, leading to an increased risk of dependence, addiction, overdose and reduced quality of life. Some research also has shown that long-term opioid use may actually make people more sensitive to pain — a condition called opioid-induced hyperalgesia.
A range of alternatives to opioid medications exists for managing chronic pain. They include other pain-relieving medications that don’t contain opioids, such as acetaminophen, naproxen sodium and nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen.
Physical and occupational therapy, stress management, relaxation techniques, acupuncture and biofeedback all have been shown to have a positive effect on chronic pain, too. Incorporating cognitive behavioral therapy, in which a therapist works with patients to learn more effective, positive ways to cope with chronic pain, also has been shown to be useful in dealing with pain.
Many health care organizations, including Mayo Clinic, offer pain rehabilitation programs that help people taper off opioid pain medications while learning about these and other pain-management techniques.
Non-opioid approaches to managing chronic pain not only eliminate the risks of addiction and overdose, in many cases, they also offer more effective pain relief that lasts longer and allows people to maintain a higher quality of life than is possible with ongoing opioid use. — Dr. W. Michael Hooten, Pain Clinic, Mayo Clinic, Rochester, Minnesota