Opioids and Persistent Pain
Narcotics for Pain Narcotic pain relievers are called opioids. Opioids are the most
effective pain medications, but also the most seriously abused.
A list of commonly used drugs with generic and trade names
appears at the end.
All opioids have about the same ability to relieve pain and the
same general problems with side effects, tolerance, and the
potential for misuse. To use them effectively for the relief of
pain, you should understand a number of things about opioid
Addiction Myths About Pain
Medicines Fear of addiction is the main reason that many people fight using
opioids for pain relief. Addiction is a compulsive use with
increasing amounts of drugs that continues despite serious
negative effects on health and lifestyle.
Addiction almost never occurs when opioids are taken as
directed for treating persistent pain.
Tolerance is the gradual loss of both the beneficial effects and
side effects of a medicine. Tolerance may develop with regular
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Myths About Pain Tolerance to side effects, such as the sleepiness produced with Medicines, initial doses of opioids, is good. Often after a few days of use,
continued the sleepiness you feel goes away and allows you to use even
larger doses of opioids for severe pain without excessive
Tolerance to the beneficial effects, such as the ability to relieve
pain, is a problem. Over time the pain relief from the amount of
medicine you started with will gradually lessen, but should never
Tolerance can always be overcome with more medicine. If you
have persistent pain, you will need to find a balance between
pain relief, costs, and negative effects of larger doses.
Tolerance has nothing to do with addiction. If your pain
medicine stops working, talk to your doctor. It could be due to a
change in your underlying condition.
Withdrawal is the development of certain predictable symptoms
when the use of opioids is stopped too quickly. Withdrawal
symptoms include nausea, sweating, and anxiety. Withdrawal
has nothing to do with addiction.
You can easily avoid withdrawal by gradually reducing the
amount of opioids taken until they can be stopped without
Positive Changes You take opioids to make your pain better — and to make your
life better. For most people, this means resuming activities that
were stopped by your pain and illness.
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Positive Changes, Take advantage of the opportunity that pain relief brings to add
continued something positive to your life. If you take opioids to eliminate
your pain without improving your life, the pills may become the
focus of your life and can do more harm than good.
Talk to your family about how much the opioid is helping your
mood, function, and attitude. If the opioid is not helping, talk to
your doctor. You should not keep taking a drug that is making
your life worse.
Opioid Types Common opioids can produce long-acting and short-acting
results. See the table at the end for a list of short- and long-
Most opioids in their usual form are short acting. They take
effect in a half hour or so and relieve pain for about four hours.
Short-acting opioids, which are often combined with an over-the-
counter pain reliever like acetaminophen (Tylenol), are good to
use before you do something that usually causes pain.
Occasional use of short-acting opioids minimizes side effects
and is least likely to cause tolerance and withdrawal symptoms.
Long-acting opioids are put into a special time-release tablet,
capsule, or skin patch. The medicine is released gradually and
gives a continuous level of pain control for the effective time
specific to the medication.
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Long-Acting, continued Opioid Types,
continued The oral, long-acting versions are usually taken every 8 to 24 hours, and the patch type is designed to last 3 days.
Long-acting medicines are used when you need some pain control at all times, or at least for a longer period than the
4 hours of the short-acting type.
Long-acting opioids can be combined with short-acting
medicines to boost the effectiveness of the pain medicine at specific times of the day, when better pain control can help you function better.
Using long-acting opioids continuously will cause some
Side Effects The side effects of opioids should be anticipated and actively managed.
The most predictable side effect of opioid treatment is constipation. If you plan to take opioids regularly, start a bowel program when you start the opioids and before you feel
If you become seriously constipated and have pain, you may need medical help. Drinking lots of liquids and taking a stool softener or stronger laxatives are usually the first step in starting
a bowel program.
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Side Effects, Other side effects you may experience include:
continued • Nausea • Slower brain function
• Fatigue • Sedation or sleepiness
These side effects usually go away in a few days without
treatment. However, you need to be careful and think about how
to avoid falls and accidents when the medicine is making you
If side effects continue, talk to your doctor about other opioids or
steps you can take to minimize the side effects you are having.
Regular Doctor You will need to visit your doctor regularly while you take Visits opioids to evaluate how effective the treatment is, discuss side
effects, and adjust your medicines.
Don’t forget that the success of your pain management will be
decided mostly by what you do with your life now that your pain
morphine MSIR, Roxanol Short-Acting Types
oxycodone OxyIR, Oxyfast,
oxycodone Roxilox, Roxicet,
Percocet, Tylox, (with acetaminophen)
hydrocodone Vicodin, Lorcet, Lortab, Zydone, Hydrocet, (with acetaminophen)
hydromorphone Dilaudid, Hydrostat
morphine MSContin, Oramorph Long-Acting
SR, Kadian, Avinza
fentanyl Duragesic patch
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