Research Reveals Opiate Pain Meds Not Effective for Long—Term Pain Management

Painkillers have become a subject of growing controversy. The news is full of headlines decrying the pharmaceutical industry for producing opiate pain relievers that cause more harm than good. We hear stories of millions of Americans who took painkillers for pain but who ended up hopeless addicts to the very drugs which were supposed to help them.

Nevertheless, patient advocacy groups, some doctors, and of course, the pharma companies themselves insist that millions of American patients need these drugs to cope with chronic pain. Some would say that some chronic pain conditions are so severe that pain pills are a must for certain patients to cope with day-to-day life.

However, even this reasoning for the use of pain drugs has been brought under scrutiny. The evidence suggests that painkillers are not that effective at reducing pain levels, particularly during periods of extended use.

What’s the story here?

Exploring the Data

Surprisingly, this story is not a new one. The medical community has known as far back as the mid-2000s that prolonged opioid therapy can lead to reduced efficacy. This truth was still present even when dosages were increased.

Quoting a study published by the U.S. National Library of Medicine: “Considering the potentially serious, adverse effects of opioids, the idea that pain relief could diminish over time may have a significant impact on the decision to embark on this therapy, especially in vulnerable individuals. Possible loss of analgesic efficacy is especially concerning, considering that dependence may make it hard to withdraw opioid therapy even in the face of poor analgesia.”

The study goes on to talk about how analgesics seem to perform well in the short-term. A three-to-seven-day prescription can be helpful for post-op pain and other acute symptoms but efficacy drops the longer opiates are used. Traditionally, doctors have explained away this loss in function by suggesting that patients were merely developing a tolerance to their opioid regimen.

But that argument didn’t stand up when it was discovered that, even if doctors increased the dosage, pain relievers would continue to lose efficacy. It would seem that there is something else about the use of opiates in pain management that makes them less effective in the long-term.

Pain Patients Can Become More Sensitive to Pain

An article in PainEDU weighed the pros and cons of different pain management therapies. While the author suggested that opioid analgesics are appropriate in some circumstances, there is much about them that is concerning and even dangerous.

For example, in addition to pain meds losing their efficacy over time (even when dosages are increased), the PainEDU article suggests that patients on long-term pain management with opiate drugs become more sensitive to pain stimuli. Quoting the article, “Some postulate that long-term use of opioids can lead to a phenomenon known as ‘opioid-induced hyperalgesia.’ When this occurs, the person actually experiences increased sensitivity to painful stimuli.”

The article goes on to cite a long list of other adverse side effects of opiates, including:

• Constipation
• Nausea
• Respiratory depression
• Cognitive impairment
• Urinary retention
• Itching
• Swelling
• A reduction of testosterone levels in men
• A decrease in estrogen levels in women
• Decreased sex drive
• Tiredness

And that’s not all. As a patient continues to take painkillers, his body begins to build up a tolerance to the drug. He needs more painkillers in order to achieve the desired effect. And as the pills become less and less effective, the patient takes more and more of them, further building up his tolerance to the drug. It’s a vicious cycle.

The Centers for Disease Control and Prevention Weighs In

The CDC has made its statement on this point. And it was a definite statement. The CDC announced that doctors should always attempt to be as conservative as possible when prescribing opiates. Lowest dosage possible, for the shortest period possible. The CDC has known for a long time that opiates lose efficacy over time. The CDC has also known about the addictive nature of these drugs.

“When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids….”

Here’s a quote from the CDC’s prescribing guidelines. “When opioids are started, clinicians should prescribe the lowest effective dosage. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”

In fact, the CDC encourages doctors not to use opioids at all, if it can be helped. “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Seeking Alternatives

It would seem that not only are painkillers highly addictive and habit-forming, but these drugs are not all that effective in treating long-term pain. After periods of extended use, opiate painkillers tend to lose their efficacy, leaving patients with risks for chemical dependency and a resurgence of pain symptoms.

When we add the addictive nature of opioids to the loss in efficacy during long-term use of such drugs, we must seriously consider if utilizing opioid-based pharmacologic therapy is the right move for treating pain. With such high risks and a questionable result, is it really worth it?

Patients should ensure that they are informed on the drugs they are taking. They need to do their own research. They shouldn’t just take their doctor’s word for it. And just as important, patients should consider seeking alternatives to opiate painkillers. Opiates still have their efficacy in short-term, post-surgery use and palliative care. But it is safe to say that the drugs are immensely overused. And they’re dangerous. The thousands dead from overdoses and the multi-million dollar lawsuits against pharma companies in retribution for those deaths are evidence enough of their danger.

It’s time to seek alternatives.

For those who have unfortunately fallen prey to an addiction to opiates, the best course of action at that point is to seek treatment at a qualified drug rehab center. Opiate painkillers are addictive. Whether one began using them under physician guidelines or not, the only way to safely treat opiate addiction is with the help of a rehab center. If you know someone who is hooked on these drugs, make sure they get help today.

Sources:

• https://www.ncbi.nlm.nih.gov/pubmed/18574357
• https://www.painedu.org/pain-medications-long-term/
• https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf

Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP