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Chronic Pain: Why Should Opioids Be Reserved As A Last Resort?

If you look around this blog, you will clearly see that I believe opioid medications should NOT be a first line treatment for chronic pain conditions.  Today I would like to raise a few points as to why I think this is the case.  I know there are many people who use this form of therapy for chronic pain and who would refute my arguments. Perhaps for them this post is too little, too late. But for those of you who are contemplating various treatment modalities, here is what I'd have to say...

During the 1990's physicians believed that patients using opioid medications for pain would not have problems of addiction if they took medications as prescribed.  In the years that have passed since then, we have learned that this is not really the case.  Addiction can develop very rapidly. According to the Cleveland Clinic, there are 15,000 to 18,000 deaths per year in the U.S. due to overdoses.

There are also a number of side effects associated with opioid usage, including sedation, constipation, hormone imbalances, and respiratory depression.  

Tolerance to the pain relieving properties of opioids develops over time.  When used chronically this means that increasingly higher doses of a pain medication may be necessary to achieve the same level of relief.  This being the case, any time  a person who uses chronic opioids undergoes surgery or a medical procedure it becomes more difficult to control their pain.  

While this may not seem significant at the outset, the risk of respiratory depression  always remains the same. So by using increasing dosages of pain medication, the risk of respiratory depression (which can lead to death) becomes more likely, and pain control may not be as adequate as we might like.

There are literally hundreds of alternative methods to control pain out there.  Depending on the particular person or condition some choices may be better than other choices, but there are still many options. Usually a number of them can be used in combination so it's up to the patient and his or her care team to find a good mix for a given situation. Some methods are easier to use than other methods...but whatever you do...don't give up!  There are always new things coming out as well!

Sources: Cleveland Clinic; Flickr


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