Q: What are opioids?  

A: Opioids are chemicals that often prescribed for the treatment of pain.

In addition to reducing the perception of pain, opioids may also induce feelings of euphoria, making them susceptible to misu

Q: Are opioids an effective treatment for pain?

A: That depends…

• Opioids are an effective treatment for acute pain. Treating acute pain appropriately at early onset may prevent the development of the chronic pain state.
• However, using opioids to manage long term chronic low back pain is of questionable benefit. (See ‘Opioids for Chronic Low Back Pain,’ published in 28 by the Cochrane Collaboration.)

Q: Are there any short term side effects associated with opioid use?

A: Yes.

In fact, one in five patients discontinues opioid treatment for acute pain because of short term side effects, which include:

• Nausea;
• Vomiting;
• Itchiness;
• Drowsiness / sedation;
• Muscle twitches;
• Slowed breathing;
• Constipation;
• Dry mouth; and
• Sweating.

Q: Are there any side effects associated with long term opioid use?

A: Yes.

Long term side effects include:

• Hormonal change, include testosterone failure in men and oestrogen failure in women;
• Sleep apnoea;
• Reduced immune functioning; and, ironically,
• Increased sensitivity to pain.

These side effects reverse after the patient stops taking opioids.

Q: Does long term opioid use do permanent damage?

A: There is not much evidence about the impact of long term opioid use.

Q: How widely are opioids prescribed?

A: Too widely.

According to the Royal Australasian College of Physicians, the Faculty of Pain Medicine, the Royal Australian College of General Practitioners, and the Royal Australian and New Zealand College of Psychiatrists, “there are disturbing indicators of a steeply increasing supply of pharmaceutical opioids and related harms, including illicit use and injecting.”

In Australia, the use of opioids in the treatment of pain has increased dramatically over the last 20 years:

• Between 1990 and 2006 there was a 40-fold increase in oral morphine usage; and
• Between 1990 and 2003 there was a four-fold increase in the prescription of Oxycodone for pain relief.

One of the dangers of prescribing pain relief medication is that the patient may build up a tolerance. This is particularly problematic with quick acting medications, where you see a peak and trough effect like being on a see-saw of pain / pain relief.

Q: Is opioid withdrawal hard?

A: In the short term, yes. In the long term, it’s probably beneficial.

Patients who withdraw from opioid use can expect a short term increase in pain. However, withdrawing has many benefits. Patients usually report that:

• A “fog has lifted”;
• They have a greater ability to concentrate;
• Constipation goes away, and other side effects dissipate;
• Testosterone or oestrogen failure reverses; and
• They experience a reduction in pain.

If a patient’s pain does not reduce following opioid withdrawal, the patient and their doctor are in a better position to understand what the cause of their pain is. This might lead to appropriate treatment of a newly identified problem. On the other hand, returning to opioid medication may be the best treatment.

Q: What other treatment options are available for people with chronic pain?

A: Consulting a doctor and coming up with a “pain plan” often works well.

Rather than the doctor prescribing a treatment plan for patients with chronic pain, a more appropriate patient plan may be for the doctor to work with the patient in working out which medication is best for them.

In coming up with a pain plan, the practitioner should consider:

• The nature of the pain problem;
• The age of the patient;
• Other medical / drug issues that may impact treatment; and
• How the patient can be brought in as a partner.

The information above is drawn from an article by Dr Clayton Thomas, “Opioids—Panacea or Pandora’s Box,” published in RACP News, Vol 30 No 2, April 2010.

For more information about chronic pain, see our article “What’s more chronic than chronic pain?"