Most evidence suggests that opioids are not useful in chronic pain. While they may help with acute pain, they rarely change pain scores in the long run when used to treat chronic pain. While there are some differences amongst opioids, I will discuss them as a class. Side effects/risks include tolerance, addiction, overdose, impaired cognition, worsening of mood, impaired sleep, lowering of testosterone and possible effects on immune function.
If you are on a chronic opioid, it may be worth checking your testosterone level.
One notable side effect is the possible development of opioid induced hyperalgesia. This is a paradoxical worsening of pain which occurs after prolonged use. Many patients will find this impossible to believe but their opioid could actually be contributing to their pain. This may explain why some people need higher doses of opioids over time and why pain scores rarely improve in this group.
Another notable side effect is that opioid use can lead to depression. Here is a study which shows that people who were started on opioids were more likely to become depressed over time compared to those who were not started. Here is another article which discusses how mood may become worse.
According to a study published in the European Journal of Neuroscience, this is because it releases more dopamine leading to more extensive changes in normal brain chemistry.
Constipation with Opioids is common. Here are a few suggestions.
Here is a study that shows that patients with Fibromyalgia do worse when treated with opioids.
When I first started practicing pain management over 15 years ago, it was common to prescribe opioids as a pain management strategy. In fact Canada is the number 2 prescriber of opioids (per capita) in the world next to the USA.
Over time, we have been able to collect millions of patients worth of data and all of it began to point in the same direction -- opioids cause more harm than good in chronic pain. Drug companies such as Purdue spent millions trying to convince physicians that opioids were safe. They showed us flawed studies and hid data that showed harm. They hired ‘experts’ to give presentations on how opioids help chronic pain patients. Even the experts did not know that they were peddling misinformation because they were informed by the manipulated data put out by the drug companies. All of this became evident during a massive lawsuit against Purdue.
I have heard this hundreds of times. Here is a typical story…
A patient has some low back pain. After trying some basic treatment, their doctor offers them Percocet. At the beginning, it works great -- better than everything else they have tried. For a very long time, there is no escalation in the dose. Gradually, the Percocet either becomes less effective or the back pain becomes worse. 2 Percocets per day become 4 then 8. At low doses, we see a slow escalation but once we start getting to the higher doses, escalation happens much quicker. 8 Percocets become Oxycontin 10 mg twice per day. Then 20 then 40..
I have seen patients on Oxycontin 80mg 3 times per day. Every one of those patients started off with just 2 Percocets per day. All of them were sure they would never get addicted.
This is something I have noticed in virtually all my patients who are on high doses of opioids:
These patients are usually referred to me from other physicians who have started them. It has taken me up to a year to wean some people down. They generally feel better once they have been weaned.