Chronic Pain and Opioids

Just like anything else, the use of opioid to treat chronic pain has benefits and side effects. Chronic pain is a pain that lasts longer than 3 to 6 months. The Centers for Disease Control and Prevention reports in 2016 revealed that about 20.4 percent of U.S. adults had chronic pain. People with constant pain complaints of impaired physical functioning and reduced quality of life. Sometimes, chronic pain is the leading cause of disability. According to the Agency for Healthcare Research and Quality (2019), the prescription for opioid to treat chronic pain tripled from 1999 to 2015. The benefits of longterm use of an opioid to treat chronic pain are not clear. To effectively treat chronic pain, it would be beneficial to combined opioids with nonpharmacologic therapy. The nonpharmacologic approaches can be behavioral therapy for short-term pain relief and physical treatments and acupuncture. The combination of these therapies can promote the comfort of long-term pain and disability

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 In treating chronic pain, clinicians should have a set goal, which includes how the benefits should outweigh the harms. If the benefit falls short of the damage, it is advisable to taper the opioids, or change to another medication. Opioids act on opioid receptors to produce their effects. Many of them are prescription drug (morphine, oxycodone, codeine, fentanyl, and Meperidine), while some are not such as heroin. That is one of the reasons why people use heroin illegally. Its medicinal content is used to treat moderate to severe pain. As stated above, clinicians order opioid to treat a patient because the benefits outweigh the harm. However, sometimes, the prescriber or the patient can abuse the medication. There are different types of opioids, including morphine, and oxycodone. Each opioid has a high potency for abuse. Loperamide, a structural analog of Meperidine, on the other hand, is used to treat a high volume output from an ileostomy. It is the most effective anti-diarrhea agent. The medication activates the opioid receptors in the gastrointestinal receptors to slow intestinal transit. After assessing the allergic reaction, opioids are the drug of choice to treat post-operatively pain. As humans, our body contains opioid chemicals endorphins. The endorphins, when activated, relieves pain by attaching to the opioid receptors. In that situation, the endorphins would dull the perception of pain. That is why opioids are so useful for people recovering from post-operative surgery and serious injuries. During the end of life (hospice) care, opioid such as morphine can be used for comfort care when the patient feels agitated.

 If opioids have such medicinal advantage, why do people abuse it?. When there are not enough receptors for opioids to attach, there would be too many free-flowing opioids in the system that affect the brain’s reward system. This situation would make the person feel euphoric. For that matter, some people use opioids for that purpose to explore high. However, when the abuse leads to addiction, there is no cure, we can only maintain it. The abuser would be at risk for other illegal activities, and health problems, and possible death. According to Chou, R., Fanciullo, J. G., Perry G. and Fine, G. P. et al. (2009), they concluded that long-term opioid therapy was associated with increased risk of abuse, overdose, fracture, myocardial infarction, and markers of sexual dysfunction. Also, from the CDC report (2016), in agreement with Chou, R., Fanciullo, J. G., Perry G. and Fine, G. P. et al. (2009), long-term opioid therapy for chronic pain is minimal. Instead, it leads to an increased risk of serious harms that appears to be dose-dependent.” People abuse opioids either prescription or nonprescription in the name of relieving pain. Opioids are an addictive drug. Abusing opioids tends to slow down breathing; CDC report (2016) about 20,000 people die from a prescriptive opioid overdose every year in the United States of America, of which 75% are teens. Prescription of opioid does not favor heroin. That is because heroin gets to the body and brain at the same time; it produces sudden extreme euphoria that does not last long. For that reason, it is easy to get addicted to it. So, it is no wonder why heroin is more easily to lay hands on the street at an affordable price.

 On the other hand, opioids such as morphine are pharmaceutically designed to affect pain or the intended use gradual. The most recognizable opioid (agonist) drug that people mostly abuse is morphine. Opiate is meant to treat moderate to severe pain, yet some people would crush morphine into a powder form so they can snort to get an immediate feeling. The resulting harmful effects if not treated immediately, can result in a detrimental impact on health, such as respiratory depression. Clinicians always reserve Narcan towards any side effects from opioids. Narcan blocks opioids from attaching to opioid receptors; therefore, it is reserved to prevent a person from dying of an overdose. Narcan is an antagonist medication that is designed to reverse the harmful effects of an opioid overdose. Substance abuse is the intentional or unintentional use of a drug that is not consistent with medical practice, or that has not authorized by a physician. People who abuse drugs have a reason or influenced by a friend. If a physician prescribed for a patient 30 mg tablet of morphine for severe pain, it is not abuse. However, if a different or the same patient administer 30 mg of morphine by his or her personal decision to relieve pain, it is drug abuse.

 Also, methadone is designed to prevent an opioid-addicted person from feeling cravings, and not enough for them to get high when using alone. That helps avoid relapse while their brain gradually heals. Methadone is one of the Food and Drug Administration (FDA) approved medications program, designed to combines behavior therapy and medication to treat substance use disorders.  Methadone is an antagonist-agonist opioid that can trick the brain into thinking it is still getting the abused drug. Methadone makes the patients feel that they are not getting high and that they feel healthy. That helps the patient to get rid of the abused drug. In those instances, the methadone becomes an antagonist drug. Because withdrawal is less likely when the patients take the right dose, it would serve a the primary (agonist) opioid drug for the patients. However, most abusers consider methadone as a new prescription, and they would not stop using. We must regularly assess and reassess the patient at least every three months at the minimum to evaluate opioid abuse. To avoid opioid addiction, the nurse practitioner should make sure patients take opioid pain medications only as prescribed for its intended use.

References

• Agency for Healthcare Research and Quality (2019). Opioid Treatments for Chronic Pain. https://effectivehealthcare.ahrq.gov/topics/opioids-chronic-pain/protocol
• CDC (2016) Guideline Assessing Benefits and Harms of Opioid Therapy for Chronic Pain https://www.cdc.gov/drugoverdose/pdf/assessing_benefits_harms_of_opioid_therapy-a.pdf.    https://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-providers-a.pdf
• Chou,  R., Fanciullo, J. G., Perry G. and Fine, G. P. et al. (2009) Opioid Treatment GuidelinesClinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain.Opioid Treatment Guideline. The Journal of Pain, Volume 10, Issue 2,  Pages 113-130
• Shannon, R. K., Bredley, J. A., Bailey, L. G., and Stein, D. M (2018). Factors associated with Naloxone administration in an opioid-dependent sample. Journal of substance abuse treatment, V. 84, P. 17-20