While some people endure the pain stoically, others will do almost anything to rid themselves of the problem. But some major pain medications have tremendous side effects that can bring on trouble if a medical professional does not monitor their use, including an increase in pain.
Some 116 million Americans are estimated to suffer from chronic pain. But how to provide relief is a long-term issue for medical professionals. The risks of treatment include drug tolerance, which calls for increasing the effective dose; addiction, which brings on withdrawal symptoms and its own anxiety; and hyperalgesia, an increased sensitivity to the pain being experienced.
Addiction Concerns
Of those, the fear of addiction is the biggest issue. Estimates of just how many become dependent on the drugs used to combat chronic pain range from an extreme low of 3 percent to as much as 40 percent of people taking the drugs. The wide range is attributed to various factors, including a lack of research on long-term effects, the different ranges in the amounts of treatment, differing populations studied and the research measures used to determine addiction.
The pain relievers with the biggest risk of addiction are so-called opiate pain relievers. Although safe for general use when taken under the care of a doctor, their relaxation of pain also comes with a danger that the warm cocoon of soothing relief they provide and the effect on brain chemicals can lead to a reliance on them to function. This is particularly true for those who have a family history of substance abuse or those who have past drugs or alcohol dependency problems.
Beyond addiction concerns because of their narcotic effects, opiates can cause such problems as diarrhea, nausea, appetite loss, sleep problems, anxiety, headaches, libido loss and weight gain. In some cases, they can lead to constipation, dizziness, cough, dry mouth, blurred vision, confusion, drowsiness and general fatigue.
Because opiates are controlled substances, they are only available legally with a prescription, and medical professionals generally only prescribe them for a short duration. However, there is a thriving black market for pills, and those with recurring pain may be driven to seek out the drugs, no matter the consequences.
Unfortunately, it is that element that makes medical professionals wary of prescribing opiates and sometimes too cautious about cutting off the supply before patients are fully recovered from the pain that led them to treatment. This is particularly tragic when the patient suffers from cancer or some other life-ending ailment that brings acute pain.
History and Opiates
Opiates (sometimes referred to as opioids) date back as far as the ancient Sumerians of Mesopotamia. They were among the first people in recorded history to cultivate and use the poppy plant, which they referred to as the joy plant. The use of poppies as a medicinal source soon spread throughout civilization.
But in the 19th century, new concerns arose with the arrival of morphine, an opium extract. It was soon noticed that while morphine relieved pain, stopping its use induced withdrawal symptoms. So it was that a new derivative, heroin, was created and introduced to the medicine field.
Ironically, heroin was initially touted as less addictive and more effective than morphine and was legally marketed in the early 20th century in pill form. The young hipsters of the age began snorting crushed pills, enjoying the euphoric feeling induced by the wonder drug. Of course, in a nation where stern moralists would soon enact Prohibition, this use of the drug was quickly quelled.
Noticing that people were beginning to use opiates for more than medicinal purposes, moves were made to regulate their distribution among populations of several nations. This moralism prevailed for much of the 20th century, causing suffering among those who could have benefited from long-term treatment under medical supervision. But in the 1990s, this attitude began to change among medical professionals.
Unfortunately, the loosening of attitudes by the medical professionals in their legitimate pursuit of palliative relief for their patients was also accompanied by a rise in non-medical uses by the general population. From 1990 to 2004, the number of those identified as abusers of opiates rose from more than 600,000 to about 2.4 million, while emergency room visits for opiate abuse rose 45 percent. Treatment admission for opiate abuse also rose 186 percent. This, of course, led to intense debate among the medical community as it sought a balance between treatment and addiction, a debate that is ongoing today.
One dilemma facing physicians is assessing which patients are making legitimate complaints about chronic pain and which are merely expressing discomfort that comes from withdrawal from opiates. They both present similar complaints, and experienced drug abusers know how to make their cases more convincing. There is much evidence to suggest that hyperalgesia, the increased sensitivity to the pain being experienced upon withdrawal from drugs, is a very real condition for those truly suffering from chronic pain and not just a drug abuser hoping to get a prescription renewal at a higher dosage.
This leaves medical professionals with a dilemma because prescribing drugs comes with a grave responsibility, one that is heavily scrutinized by medical boards and regulators. Writing prescriptions for the wrong people can result in legal action and a loss of license, making for a higher hurdle for prospective patients who may seek relief from perceived pains.
Pain specialists and other medical professionals continue to assess the delicate balance between managing pain relief and avoiding addiction. Acknowledging that drug abuse has skyrocketed, the medical community is working to develop strategies that will aid those truly in need of relief while walling off substance abusers. It’s an ongoing struggle that may result in greater monitoring of patients who are seeking pain relief, both in home and clinical settings.