Prescription Painkillers Not For Everyone

Get a second opinion before starting opioids

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Contributor: Teresa Dews, MD, Department of Pain Management

If you’re struggling with chronic pain, don’t be too quick to pin your hopes on the prescription painkillers known as opioids.

These drugs, which include OxyContin® and Percocet®, have a long list of down sides and should be viewed as a last resort for chronic pain, says Teresa Dews, MD, of Cleveland Clinic’s Department of Pain Management.

“Opioids have significant side effects and they are not effective for all patients with chronic pain,” explains Dr. Dews, who specializes in managing chronic pain. “Plus, patients frequently develop dependency on these medications despite a lack of benefit for their pain.”

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The effects of opioids — including their addictive qualities — are a big contributor to the nearly 15,000 U.S. deaths from painkiller use that occur each year, according to the Centers for Disease Control and Prevention.

Some of those deaths are due to serious complications after using the drugs as prescribed — usually at high doses. Others are due to misuse of the opioids because the patient becomes addicted. And some are the result of addiction-related abuse of opioids by people who get them illegally without a prescription.

Not a perfect solution 

“Many patients have been led to believe that opioids are a cure-all for pain, but that’s not true,” says Dr. Dews. “Many, many patients who take these medications still have significant pain and have little improvement in their physical function.” She adds that in some patients, long-term opioid use can actually lead to increased sensitivity to pain.

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In addition to addiction, the potential side effects of opioids include effects on the immunologic system, hormonal changes, constipation, worsening pain (known as “opioid-induced hyperalgesia”) and increased risk of anxiety and depression.

Explore alternatives first

“At Cleveland Clinic, although we do manage some chronic pain patients with opioids, they are not the mainstay of therapy,” Dr. Dews says. Many alternative therapies are considered first, often in combination, including the following:

  • Non-narcotic drugs with pain-relieving effects such as antidepressants and anticonvulsants
  • Procedures aimed at blunting the source of pain, such as nerve blocks, spinal cord stimulation, nerve stimulation or minimally invasive surgical procedures
  • Intraspinal infusion of pain-relieving drugs

If these alternatives are not effective or appropriate, opioids may be considered for chronic pain, Dr. Dews says, but only after the patient is assessed for substance abuse risk. And they must sign a medication agreement laying out rules for regular evaluations and oversight.  If a patient’s treatment goals are not reached, opioids are then discontinued.

“Patients who are being considered for chronic opioid therapy have good reason to consult a pain clinic like ours for a second opinion and additional options before they commit themselves to a chronic opioid regimen,” says Dr. Dews. “The stakes — good pain relief and avoidance complications — are too high not to explore this thoroughly.”

Dr. Dews sees patients at multiple pain management locations throughout the Cleveland Clinic health system. To make an appointment, call 216.444.PAIN (7246).

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