Why Opioids Aren’t the Best Way to Treat Chronic Pain

Why Opioids Aren’t the Best Way to Treat Chronic Pain


Many people assume that because opioids are powerful painkillers that it makes sense to use them to treat chronic pain. Opioids are great for treating the pain that comes immediately after a serious injury, surgery, or other medical procedure, especially when a patient’s opioid use is limited and closely monitored. While opioids are great for treating acute pain in the short term, they may cause serious problems when used over a longer period of time, as when treating chronic pain. 

Opioids are addictive.

The biggest problem with using opioid painkillers over a long period of time is that they are highly addictive. According to the Mayo Clinic, even taking opioid painkillers for as little as five days can significantly increase the risk that you will still be taking them a year later. Opioids are most dangerous for people with a personal history or family history of substance use disorders but you don’t have to have such a history to develop a physical dependence or addiction. 

For many people, being prescribed painkillers following surgery or another medical procedure is their first exposure to opioids and many people have developed serious addictions as a result of this exposure. Doctors are increasingly aware of the danger opioids pose to patients and they are becoming more reluctant to extend prescriptions. As a result, many people who started taking opioids as prescribed eventually switch to drugs like heroin or fentanyl, which are cheaper and easier to get. In 2017, there were more than 47,000 overdose deaths from all opioids, more than a third of which were from prescription painkillers. 

Opioids increase your pain sensitivity. 

Part of the reason opioids are so addictive is that your body develops a tolerance, which actually increases your sensitivity to pain. Pain is a normal function of your body and brain. It lets you know when something is injured. So when you can’t feel pain for a certain period of time because you’re taking opioids, you brain adjusts. Another way to say this is that opioids diminish pain signals, so you become more sensitive to pain. You need to take more of the drug to have similar effects, which increases your risk of addiction. Having an increased sensitivity to pain also means that if you reduce or quit taking opioids, you will feel more pain than you did before. That’s the opposite of what you want but the tolerance trap is difficult to escape. There is even a condition called opioid-induced hyperalgesia, in which opioids make you more sensitive to pain–either the original pain you’re trying to suppress or a completely new pain that you didn’t have before. 

Opioids mask emotional pain.

Opioids don’t only relieve physical pain; they relieve emotional pain as well. It turns out that the same neurological mechanisms are responsible for both kinds of pain even though the causes are quite different. This is one reason why people with a history of mental health challenges, abuse, or trauma are at greater risk for developing substance use issues. Even people who take opioids as prescribed might discover that the drug also relieves their painful emotions and have trouble quitting. 

While developing an addiction is probably the biggest concern, another problem is that emotional pain needs special attention. It’s tempting to switch off the pain with a pill rather than doing the work of therapy and emotional development. Just as untreated injuries can be debilitating, untreated mental health issues typically get worse and cause more problems. As unpleasant as it is, feeling emotional pain can prod you into getting help, which is better for you in the long run.

There is also a practical reason to treat mental health issues in therapy: emotional pain makes you more sensitive to physical pain. People who are depressed and anxious are likely to experience pain with greater intensity. If you do have issues like major depression, anxiety, or PTSD, getting them treated can significantly reduce your physical pain as well.

Opioids have harmful long-term side effects.

Even if you do manage to keep your opioid use at a low enough level that there’s little danger of an overdose, you are likely to experience negative side effects when using opioids for a long time. Opioid use can affect many major systems and lead to problems such as constipation, sleep apnea and other sleep-disordered breathing, increased risk of heart attack and heart failure, dizziness, sleepiness, hyperalgesia, increased risk of accidents and fractures, sexual dysfunction, fatigue, low testosterone, and immune dysfunction, leading to more illnesses.

What to do instead.

If you’re struggling with chronic pain, it’s typically best to see a chronic pain specialist who will be aware of current treatment treatment modalities. As noted above, getting therapy for any mental health issue as well as for chronic pain itself can reduce your sensitivity to pain. Physical therapy is often an effective way to reduce pain, especially back and joint pain. Perhaps surprisingly, moderate intensity aerobic exercise has also been shown to be effective in reducing sensitivity to pain, assuming that such exercise doesn’t aggravate an injury. Finally, while opioid painkillers get all the attention, there are many effective pain medications that are non-addictive and comparatively safe. There are many NSAIDs that work well for chronic pain and even over-the-counter medications can be surprisingly effective. 

At Patrick Hart Consultants, we provide a number of different services to fit the needs of each individual client. Among these, are helping you choose a treatment provider, helping you develop a treatment plan, helping you establish post-treatment support, and ensuring continuity among the different elements of treatment. Contact us today at 844-262-7970 or Info@PatrickHartConsultants.com or explore our website for more information.

AUTHOR: Hart Consultants