For some chronic pain patients, prescription painkillers are a part of the treatment plan. The risks of long-term use of opioids have been well-documented and include things like dependence, loss of efficacy, and sleep apnea or depressed breathing. Being aware of the risks is just the first step of safely taking prescription painkillers. With a few considerations, it is possible to reduce the risks of these medications if they are needed to treat your pain.
Consult a pain specialist
One of the first and most powerful steps to reduce risks associated with prescription painkillers is to discuss your options openly with a doctor. Consulting with a pain specialist is a great way to design a treatment plan. Pain specialists have a deeper understanding of innovative pain techniques and treatments than a primary care physician and may present more options.
A pain specialist will generally follow these steps:
- Take a thorough history. Patients with previous issues of drug use or dependence are at higher risk for dependence on prescription painkillers.
- Conduct a medical exam. This will include blood work, physical examination of the affected area, and observation of the area in action (i.e., for knee pain observing standing, walking, etc).
- Explain treatment options. Prescription painkillers are not the only way to handle chronic pain, and some chronic pain does not respond well to them. Other treatment options may include over-the-counter medications combined with changes in diet and exercise. There are non-invasive and minimally invasive surgical techniques that can be used to address chronic pain, and complementary medicines such as acupuncture and biofeedback may also be appropriate.
- Design a treatment plan. A pain specialist will design a treatment plan tailored to the individual patient.
- Monitor and reassess. This part is crucial for success and healthy treatment, especially when prescription painkillers are part of the treatment plan. Patients will meet regularly with doctors to take stock of the efficacy of the treatment and monitor for signs of drug dependence.
- Re-design the plan. If patients are responding well to the treatment plan and it is possible to lower or eliminate prescription painkillers, doctors will change the treatment plan as needed.
Some patients with chronic pain have a hard time dragging themselves to the doctor. Some don’t want ot admit they are in pain, some are scared by what they might find out, and some might want to try to deal with it themselves. It is important to remember that chronic pain is pain that does not resolve itself, and a pain specialist can help treat the condition appropriately. Some patients might try to “borrow” a friend’s prescription painkillers to treat themselves. Not only is this illegal, but it is a high-risk proposition. Seeing a pain specialist is a good start to managing chronic pain while keeping painkiller risks low.
Take your medicine
If prescription painkillers are recommended for pain management, it is important to take them on time, every time, in the appropriate dose. Patients with chronic pain have good days and bad days. On good days, it may be tempting to ignore the prescription and then over-do it, causing even more pain. Almost 50% of patients do not take their prescriptions properly, and this diminishes their effectiveness dramatically.
Reasons for this vary and can include:
- Lack of literacy. Patients are unable to read or understand the prescription as written.
- Ill health. Patients may be unable to take the medication on their own, or to keep it down.
- Complex regimen. The complex blend of medications may be confusing to patients.
There are other factors that deal with limited access to health care due to time constraints or transportation. All of these factors should be part of the clear communication between doctor and patient. It is important that the doctors and clinicians recognize their role in making certain that prescription painkillers are taken as prescribed, and that may mean follow-up phone calls or home visits. These two actions can help reduce the risks of side effects while helping to ensure that patients get the maximum benefit possible.
In addition to these patient-centered approaches to help reduce the risks associated with prescription painkillers, medical insurers can use prescription monitoring programs to track prescription refills and use. While prescription drug monitoring programs (PDMP) only showed a minor decrease in prescriptions up to 2008, the morphine milligram equivalents went down substantially, with a 66% decrease in Colorado. Other studies indicate that without PDMPs, the prescription rate continues to rise. Peter Kreiner, principal investigator of the Prescription Drug Monitoring Program (PDMP) Center of Excellence believes that the slight decrease is worth it.
“At a time when the misuse and abuse of prescription opioids has reached epidemic levels, it’s important that third party payers be able to use states’ prescription monitoring data to make sure these drugs are prescribed appropriately.”
If a patient does develop dependence on prescription painkillers, an involved doctor and a prescription drug monitoring program should catch it quickly. In this case, there are many programs and support structures to help patients safely wean themselves off the prescription.
Symptoms of prescription painkiller withdrawal can be severe and include the following:
- Muscle aches
- Increased tearing
- Runny nose
- Abdominal cramping
- Dilated pupils
- Goose bumps
Severity depends on the length of time a person has been taking opioids. Some patients who have surgery and spend several days in the hospital recovering with the use of prescription painkillers may have what they feel is a small cold, but is in fact minor withdrawal symptoms.
Patients who do not take precautions or keep an open dialogue with their doctors as they treat their chronic pain run the risk of not only dependence but also accidental overdose as the amounts of prescription painkillers needed to treat pain increases. Prescription opioids remain the number one overdose-causing drug in emergency rooms, so addressing the issue effectively could be a matter of life or death. More and more opioid overdose preventions programs (OOPPs) are turning to kits that contain the drug naloxone to help reverse the effects of opioids.
Prescription painkillers can be effective and safe for some types of pain relief. Tell us about your experiences with them.
Image by Jason Rogers via Flickr