Understanding Opioid Medicines for Pain Management

Opioids are medicines that can help ease pain. They are stronger than most over-the-counter pain relievers and must be prescribed by a healthcare provider. They can be used to treat both acute and chronic pain that ranges from moderate to severe. Opioids can be safe and effective when used correctly. But they do come with serious risks and side effects. For this reason, they should be used only if other medicines or treatments have not done enough to ease or manage pain.

What is pain?

Pain is your body’s way of telling you something is wrong. It makes you pull your hand away from a flame or avoid walking on an injured leg. Pain starts in receptor cells found beneath the skin and in organs throughout the body. When you are sick or injured, these receptor cells send signals along nerve pathways to the spinal cord, which then sends the signals to the brain. The brain interprets the signals as pain. In response, it sends back signals to protect the body. The brain also releases its own natural painkillers called endorphins to help reduce pain. Once the source of the pain heals, the pain often goes away.

Types of pain

Pain can one be of two types: acute or chronic. Both types respond to treatment.

• Acute pain typically lasts fewer than 3 months. It goes away when the cause is treated. Common causes of acute pain include injury or illness. Surgery can lead to short-term pain during healing. And women have acute pain during and after childbirth. In some cases, acute pain can lead to chronic pain over time.

• Chronic pain often lasts longer than 3 months. This includes pain that comes and goes or that is continuous. Chronic pain may be due to an ongoing health problem, such as arthritis. Or it may linger after an injury that has healed, such as a broken bone. Problems with the body’s pain-control system may also lead to chronic pain. Sometimes, chronic pain can occur with no clear cause.

The pain cycle

Pain can affect all aspects of your life. For example, sleep, mood, activity, and energy level are all affected by pain. Being tired, depressed, or inactive makes the pain worse and harder to cope with. This leads to a cycle of pain.

How opioids work

Opioids work by attaching to special receptors found in the brain, spinal cord, and other organs. When opioids attach to these receptors, they can block or suppress how you feel pain. Opioids can also make you feel good or relaxed. They affect areas of the brain that produce feelings of pleasure.

Types of opioids

There are two types of opioids: short-acting/immediate-release (SA/IR) and long-acting/extended-release (LA/ER). Short-acting opioids work faster than long-acting opioids. But they give pain relief for only short periods. Long-acting opioids work slower than short-acting opioids. But they ease pain for longer periods. Many opioids come in both short- and long-acting formulas. They include:

• Codeine with acetaminophen

• Fentanyl

• Hydrocodone (with or without acetaminophen)

• Hydromorphone

• Meperidine

• Methadone

• Morphine

• Oxycodone (with or without acetaminophen)

• Tramadol

If you are prescribed opioids, you will likely be started on a short-acting type at the lowest dose. The dose may then be adjusted as needed based on your response to the medicine and follow-up with your healthcare provider. If appropriate, you may start using a long-acting type opioid. In some cases, you may be prescribed both types of opioids to help manage different types of pain. Any changes will also depend on how you handle pain and side effects from the medicine.

Side effects of opioids

Side effects of opioid medicines include the following:

• Constipation

• Feeling sleepy (drowsy)

• Nausea

Some side effects of opioid medicines can be life-threatening. Symptoms of opioid overdose include the following:

• Slow heart rate

• Shallow or slowed breathing

• Loss of consciousness

When taking opioids, there is a possibility of abusing the medicine, physical dependence, and addiction. Take opioid medicines only as directed by your healthcare provider.

Don't take opioids with benzodiazepines, such as alprazolam or lorazepam. Combining these medicines can have serious risks. These include extreme sleepiness, slowed breathing, and death. Tell your healthcare provider if you are taking benzodiazepines.

Note

Studies show that opioids provide short-term help for moderate to severe pain. But the benefits of long-term use of opioids for treating pain remain unclear. You should only stay on opioids if they continue to improve pain and function without raising the risks to your health.

How opioids are given

Most opioids are taken by mouth. They often come in pill form. But some may come in the form of liquids and even sweetened lozenges. Certain opioids also may be injected under the skin, into a muscle, or into a vein. Or they may be absorbed through the skin via a patch.

Know your options

Keep in mind that opioids are not the only option for treating pain. Nonopioid options may work just as well. They may have fewer risks and side effects. Talk with your healthcare provider about which treatment plan is right for you. Nonopioid options can include: 

• Other pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen

• Other classes of medicines such as anticonvulsants, antidepressants, and muscle relaxers

• Exercise and physical therapy

• Cognitive behavioral therapy, which can help you learn different ways to respond and cope with pain

• Mind/body therapies such as deep breathing, distraction, visualization, meditation, or biofeedback

• Complementary therapies such as massage, acupuncture and acupressure, or chiropractic care

• Various procedures, such as transcutaneous electrical nerve stimulation (TENS), implantation of a spinal pump, and nerve ablation