Opioids for Chronic Pain
Learn More About Common Pain Conditions, Their Origins, and Mechanisms
Opioids
Opioids are a class of drugs derived from opium, which occurs naturally in the poppy plant. They act on the central nervous system, producing various effects, particularly pain relief. Due to their effectiveness, opioids are often used to treat moderate to severe pain.
Side Effects and Risks
The use of opioids can lead to side effects, which vary depending on the dosage and individual factors. Common side effects include nausea, constipation, itching, increased sweating, drowsiness, confusion, and, in severe cases, respiratory depression. Therefore, opioids should only be used under medical supervision. Opioids can lead to physical dependence, and uncontrolled use can result in psychological dependence or addiction. Patient-specific factors, such as age, comorbidities, concurrent medications, pre-existing substance use disorders, and psychiatric comorbidities, can significantly increase these risks. Before starting opioid therapy, a detailed medical assessment of the benefits and risks is always required to avoid serious complications.
Indication Criteria
National and international guidelines distinguish between the medical use of opioids for cancer-related and non-cancer-related pain. Chronic non-cancer pain should, whenever possible, not be treated with opioids. Scientific evidence suggests that opioids are not more effective than other pain medications for chronic non-cancer pain. Therefore, other therapeutic measures should have been tried or at least considered before starting opioid therapy.
According to the German AWMF guidelines on the use of opioids for non-cancer pain, opioid therapy may be considered for the following conditions:
- Pain in diabetic polyneuropathy
- Pain after shingles / postherpetic neuralgia
- Chronic osteoarthritis pain
- Chronic back pain
- Phantom pain
- Chronic pain after spinal cord injury
- Chronic pain due to nerve root damage
- Chronic pain in rheumatoid arthritis
- The duration of treatment should ideally be limited to 4 to 12 weeks. During this period, other therapeutic options should be evaluated and attempted so that opioids can be discontinued later. Opioid therapy should only be continued beyond 12 weeks if there is a clear, significant reduction in pain.
There are also clear recommendations on when opioids should not be used:
- Headaches (migraines, tension headaches)
- Chronic pelvic pain in women
- Irritable bowel syndrome
- Fibromyalgia syndrome
- Chronic inflammatory bowel diseases
- Chronic pancreatitis
- Various psychiatric disorders
Unwanted Effects of Long-Term Use
Long-term opioid use can lead to the following unwanted effects:
- Loss of sexual desire
- Impotence
- Menstrual irregularities
- Increased overall mortality
- Passivity / lack of drive
- Memory impairment
- Increased risk of falls
- Dependence and Addiction
Opioids lead to physical dependence. When used correctly with proper indication and dosage, along with regular medical reevaluation, the risk of addiction is low. However, in cases of questionable indication and uncontrolled use, there is a significant risk of developing psychological dependence or addiction.
Discontinuation of Opioid Therapy
Opioid therapy should be periodically reevaluated and conducted only under regular medical supervision. If there is no clear benefit, the treatment should be strongly reconsidered, and a gradual reduction and cessation of opioids should be pursued. In cases of doubt, an outpatient intravenous opioid test can help decide whether to continue the treatment.
FREQUENTLY ASKED QUESTIONS
Opiates are a group of powerful pain-relieving substances that are derived from the juice of the opium poppy or can be synthetically produced. Opioids are synthetically manufactured substances that, like natural opiates, act on opioid receptors in the human body. Both affect the central nervous system. They are used to treat moderate to severe pain, such as that which can occur after surgeries, in cancer patients, or from serious injuries.
Some well-known opioids, which are either naturally found in the opium poppy or synthetically produced, include: morphine, codeine, oxycodone, and fentanyl.
It is important to note that opioids can be potentially addictive and, if used improperly, can lead to abuse, dependence, and serious side effects. These include respiratory depression (slowed breathing) and overdose. Therefore, opioids should only be taken under strict medical supervision and according to a doctor's instructions. In some cases, opioids are used to treat drug addiction by being replaced with other medications like methadone or buprenorphine, which alleviate withdrawal symptoms and reduce the craving for opium derivatives.
This is an important but not easily answered question, as there are many medical and legal uncertainties. It can be noted that certain medications can impair driving ability. The following key aspects should be considered.
**Classes of Painkillers**: Some painkillers, particularly opioids, muscle relaxants, antidepressants, and antiepileptics, can cause drowsiness, dizziness, and slowed reaction times, which can impair driving.
**Individual Reactions**: The effects of pain medications can vary from person to person. Some people may be more affected by the sedative effects than others.
**Consultation with Doctor or Pharmacist**: It is advisable to get information about possible effects on driving ability before taking pain medications. A doctor or pharmacist can give you recommendations on whether you can safely drive while taking certain medications.
**Warnings on Medication Labels**: Many pain medications contain warnings about operating vehicles or machinery.
**Alternative Transportation Options**: If you are unsure whether you can drive safely while taking pain medications, you should consider alternative transportation options such as public transport, taxis, or the support of friends or family members.
Ultimately, it is the individual's responsibility to ensure they are able to drive safely without endangering themselves or others. If there are doubts or concerns about driving ability, it is best to refrain from driving and choose a safer option.
