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Opioids are the strongest painkillers we can prescribe. They include medications like codeine, tramadol, morphine, oxycodone, buprenorphine and fentanyl. They can be helpful when used for a short period of time to manage acute pain like after an operation or a serious injury.
Opiate medications are very strong drugs that should only be used as a short-term measure to help combat acute pain. They can be highly effective in relieving pain, but they also carry a risk of dependence, addiction, and overdose. If taken over a period of time, individuals can develop serious side effects that can have a negative impact on their quality of life. Here are some of the risks associated with opioid use:
1. Addiction: Opiate medications have a high potential for addiction and dependence, even when taken as prescribed. People who use opiates for an extended period may develop a physical dependence on the drug, leading to
withdrawal symptoms when they try to stop using it.
2. Overdose: Opiate medications can cause respiratory depression, which can lead to death if the dosage is too high. Overdose is more likely to occur when
the medication is taken in a way that is not prescribed or using them with other drugs or alcohol.
3. Tolerance: Opiate medications can cause tolerance, meaning that over time, the body becomes less responsive to the drug’s effects. This can lead to the need for higher doses to achieve the same pain relief, which increases the risk
4. Side effects: Opiate medications can cause a range of side effects, including dizziness, nausea, constipation, and drowsiness. These side effects can affect a person’s ability to drive or operate machinery safely.
5. Interactions with other drugs: Opiate medications can interact with other drugs, including prescription medications, over-the-counter drugs, and illegal drugs. These interactions can increase the risk of side effects, overdose, and
• You’ve been taking the medication for more than 3 months.
• You are regularly taking the maximum dose or more than your prescribed dose.
• You don’t feel like yourself.
• You experience unpleasant side effects or withdrawal symptoms when you miss or reduce your dose. These could include anxiety, nausea, headaches, hallucinations or difficulty concentrating.
• You watch the clock, waiting until you can take your next dose, does the thought of missing one causes anxiety?
• You might be buying it illegally or taking medication that has been prescribed to others.
• You visit different doctors or pharmacists to try and get extra medication.
• You get angry or upset when someone mentions how much medication you’re taking or how often you’re taking it.
If you recognise any of these signs then you might be becoming dependent on pain medication. Contact a pharmacist or GP at your practice to talk about alternative ways to manage your pain. Never suddenly stop taking your medication, this can be extremely dangerous. Discuss with your pharmacist or GP how to gradually reduce your dose.
Opiate medications work by blocking pain signals in the brain and over time the body can become accustomed to their presence, leading to a tolerance to the drug. Tolerance means that the body requires higher and higher doses of the
medication to achieve the same level of pain relief. Eventually, the body may develop a tolerance to such a degree that the medication is no longer effective at all.
Acute or short-term pain usually happens in response to an injury, trauma or damage to the body such as nerve damage, broken limbs etc. In acute pain, the use of pain medication can be very effective. However, after 3-6 months the original damage to the body has usually healed or settled as much as it is going to (unless it is due to an inflammatory condition such as arthritis). Scientific research has found that pain that lasts longer than 3 months is likely to be due to changes in the nervous system rather than as a result of ongoing damage or injury. Therefore, tests such as X-rays and MRI scans that look at the state of tissue are often negative or inconclusive and therefore are not often needed. This means that pain is a result of a sensitised nervous system, which X-rays and scans are unable to detect. The pain that is felt is then due to the body becoming very sensitive and giving off pain signals in an uncontrolled way. In this case it is called long-term or persistent pain. No one knows why this happens in some people, but it is a common condition that affects more than 1 in 5 people in the UK (British Pain Society).
As after 3-6 months your body would have healed or settled as much as it is going to, taking pain medication for longer runs the risk of you becoming unintentionally addicted. In fact for chronic pain the benefits of opioids are limited, clinical evidence shows that the use of opioids for the management of chronic pain is ineffective and has the potential to be harmful. This kind of pain needs to be managed in a different way than acute pain. Chronic pain can have a severe impact on your quality of life and many people who suffer from chronic pain, long for a quick solution to stop pain completely. The purpose of this information is to inform you that long-term opioids are not always the solution. Chronic pain is complex and there can be other factors which contribute to it. Some of these may be physical; others may be emotional and social. If you think there are other factors which may be contributing to your pain, please arrange for a routine appointment with your prescriber to discuss this further.
No. Although the original damage or trauma may have healed or settled, the feeling of pain is still very real. This just means that treatments that focus on the original injury are not likely to be effective and it has to be managed in different ways.
Please take a look at these videos to understand more:
Understanding Pain in less than 5 minutes, and what to do about it!:
Tame the Beast: It’s time to rethink persistent pain:
Unfortunately, there simply isn’t a medication that will remove all pain. Each person’s experience is unique to them. Many people are not aware that there are other ways to help manage persistent pain other than medication. There are techniques you can try yourself and local support groups to meet others with similar conditions. It may not be possible to completely remove your pain, however, you can be supported to cope better with it. Things such as anxiety and stress can make your ability to manage your pain worse, and things such as a healthy diet, good sleep, gentle exercise and mindfulness can help calm down your body’s sensitivity to pain and make you better able to manage your pain. By reducing and avoiding opioid medication you could reduce the side effects from your pain medication which can in turn help you feel more alert and proactive about managing your pain, and may improve your quality of life. Speak to a pharmacist or GP at your practice for support, especially if you are thinking about reducing your pain medication as it can be dangerous to reduce this too quickly on your own.
Self-care Tools: https://www.tims.nhs.uk/self-care
Living well with pain: https://livewellwithpain.co.uk
The 10 Foot Steps Programme: https://livewellwithpain.co.uk/ten-footstepsprogramme
Tame the Beast website: http://www.tamethebeast.org
Painkillers don’t exist: https://painkillersdontexist.com/
Fillipin Pain Campaign: https://www.flippinpain.co.uk/understanding-pain/
Curable smart phone app: https://www.curablehealth.com/
GOAL SETTING: Setting, tracking and achieving goals will help you to recognise that you’re making progress.
DEEP BREATHING: When you breathe deeply it helps regulate your heart rate and blood pressure, which helps to regulate the pain response in your brain.
RELAXATION: The feeling of being calm helps the body to release tension and reduce pain by decreasing muscle tension.
SHARE YOUR EXPERIENCE: Opening up to family and friends will mean they can help you with your pain management.
POSITIVE IMAGERY: also known as visualisation, is a relaxation technique that aims to help lower the levels of stress hormones in your body
THOUGHT DISTRACTION: Distraction means shifting your attention away and use your brain to focus your attention on something else.
REDUCING STRESS IN YOUR LIFE: Stress makes it harder to deal with your pain and the problems caused by that pain
REMAINING POSITIVE: With a positive mindset it’s easier to stay motivated and look ahead.
EXERCISE: Find something you enjoy that can keep you active.
Dukinfield Medical Practice is participating in the national opioid scheme which is a national target aiming to reduce prescribing of opioids, we have started performing reviews of our patients on the highest doses of opioids. If you’d like to speak to us
sooner then please get in touch. Depending on the clinical situation and judgement we may refer you onwards for expert help.