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Chronic Pain and Opiates…Pain Specialist

Author: 10 June 2017 No Comment

Chronic Pain affects millions of Americans each year, whether it be acute or chronic.

It can be devastating and significantly decrease quality of life and productivity. It is estimated that 80% of the population will experience back pain during their lifetime. Opioids are often given to treat chronic pain, but in recent times more and more scrutiny has arisen due to increased prescription drug abuse and overdose deaths. To understand the treatment of pain, first we must discuss what “pain” is. “Acute pain” is the body’s natural response to damage such as an injury or infection. It usually starts suddenly but resolves within a few weeks, as the injured tissue heals. It is our body’s way of telling our brain that something is hurt. Often, acute pain is what sends a patient to the doctor to be evaluated. “Chronic pain” is defined as pain that persists longer than 3 months, past the time of when normal tissue healing should have occurred. Per the CDC, an estimated 116 million people a year experience chronic pain. It is often affected by physical activity, environmental changes and stress. Chronic pain can be managed, but often reduces quality of life and the ability to function long term. It can require long-term treatment with physical therapy, medications or interventional procedures. Acute pain can become chronic pain when the cause of the acute pain is difficult to treat or re-injury occurs. Cigarette smoking triples the likelihood of chronic pain developing after an acute back injury. Research has found that smoking changes the brains’ response to back pain and may make individuals less resilient to an episode of pain. The first line treatment for acute or chronic pain is Physical Therapy, often in combination with over the counter medications such as acetaminophen or ibuprofen. Physical therapy helps strengthen muscles, increase mobility and can significantly decrease pain. Physical therapists partner with patients and their families to create an exercise plan for the patient to continue long term. Also medication such as anti-convulsants and anti-depressants can decrease pain without the risk of addiction. Other options for chronic pain treatment include interventional procedures. Neck and back pain can often be treated with epidural injections, facet joint injections, depending on the location and type of pain. These can significantly decrease pain and the need for opiate medication while increasing daily functioning. Interventions may need to be repeated occasionally to decrease pain and need for opiates. When first line treatments do not decrease pain, opiate pain medications may be used. Opiates are powerful pain relieving medications that help reduce the sensation of pain when used for the right condition and when taken properly. They are not curative. They do not treat a problem; only make the problem tolerable.

Opiate medications include oxycodone, hydrocodone, morphine, hydromorphone, oxymorphone, and tapentadol, along with several other lesser known medications.

 

These medications work by binding to specific receptors in the brain, decreasing the sensation of pain. These medications can be immediate or extended release. Opiates should be used only after non-opiate medications or nonpharmacological treatments have failed to give relief. They should be used at the lowest dose for the shortest duration possible. Extended release formulations should only be used for moderate to severe pain that is present for the majority of the day, unrelieved by immediate release medication. Tolerance, the body’s natural response to long-term use of medications, can result in the dose needing to be escalated. Often this can be avoided by rotating to a different opiate, orby restarting non-pharmacological treatments, including physical therapy or interventional procedures. Opiate medications present significant risk. They can have significant side effects including sedation, euphoria and constipation. Patients with sleep apnea, kidney or liver issues, depression, and previous substance abuse should avoid opiates. New recommendations from the Food and Drug Administration suggest that opiate medications should not be prescribed to an individual also taking benzodiazepine medications such as alprazolam, clonazepam, and lorazepam. Concurrent use of these opiate medications and other sedating medications, including sleep aids, can increase the risk of overdose. Use of these medications can lead to Opiate Use Disorder. This occurs when an individual does not take the medication as prescribed, or continues to take them even when pain has resolved. These individuals are unable to decrease their dose or use of opiate, which leads to significant social problems and ability to fulfill obligations at work, school or home. This often can lead to use of illicit substances or overdose. Individuals in this situation significantly benefit from Substance Abuse Treatment programs. Overdose occurs when too much opiate medication or illicit substance is in an individual’s bloodstream, which decreases the brain’s natural programming to breathe. This can lead to death when the brain and body do not get enough oxygen. From 1999-2014there were more than 165,000 overdose deaths nationwide. Last year in the State Of Maryland alone there were 1,400 opiate overdoses, which was a significant increase from previous years. The State now recommends that patients receiving long term opiate therapy receive a prescription for Naloxone, a medication that safely and effectively reverses opiate overdose. It is imperative that patients taking opiates long-term abide by safety guidelines. More than 50% of opiate abuse starts at home- by individuals taking medication prescribed to a friend or family member. Medication should not be kept in easily accessible locations. Also, any unused medication should be returned at National Drug Take Back Days. Opiate medications are often a blessing and a curse. They give significant relief however should be used under strict supervision only, for the shortest duration of time possible. Patients experiencing chronic pain should be treated at facilities that are equipped to offer interdisciplinary treatment, including injections to keep pain tolerable without opiates, or while on the lowest dose possible.

www.mdpainandspine.com

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