Are Pain Pills Making Your Breathing Dangerously Slow?

Consider these alternatives to opioids
woman having trouble breathing

Has your spouse complained that you suddenly snore at night after you started taking opioids to manage chronic pain? Or, after starting these drugs, do you notice that you are increasingly tired or napping during the day?

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If so, these are subtle signs that your pain medication may be causing a breathing problem. Not all patients have to worry about this, but for those who do, it can be a serious or even fatal problem. The good news is that there are many treatments that can address pain without compromising respiration.

How opioids can slow your breathing

Opioids such as oxycodone, hydrocodone, morphine and codeine control your pain by attaching to receptors in the central nervous system to decrease pain signals.

However, they often have side effects. They sometimes make you sleepy, euphoric or constipated. And, for some people, they even suppress respiration, says pain management specialist Robert Bolash, MD.

Everyone breathes in and out at their own rate. This variation among people is normal. But, if you are taking opioids, you may breathe differently — more deeply and slowly than you normally would. Problems occur when opioids slow your breathing too much. This can dramatically reduce the volume of air you take in.

Factors that can increase your risk

These factors make breathing complications more likely:

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  • Existing respiratory issues– smoking, obstructive sleep apnea, lung cancer or chronic obstructive pulmonary disease (COPD), for example.
  • Taking opioids in combination with other drugs – particularly benzodiazepines (Valium®), barbiturates, phenobarbital or alcohol.

There may even be an added risk of breathing problems when taking gabapentinoids, medications that help calm nerve activity. Combining these medications with morphine may impact breathing more than the opioids used alone. Dr. Bolash says your risk increases if you are:

  • Using other depressants, such as alcohol or a sleep aid
  • New to taking a combination of pain medications
  • Elderly

Other options besides opioids

If you think your pain medication is causing a breathing problem, it’s a good idea to talk to your doctor about your risks.

Tell your doctor if you have other medical conditions that impair your breathing. This may influence the type of pain medication he or she prescribes.

There are also a whole host of other pain management options that can work better, and there is a general trend to avoid opioids due to their many side effects, says Dr. Bolash.

Here are some other pain management options:

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  • Transdermal medication (absorbed through the skin) for a specific focal point of pain
  • Nerve-block injections to help decrease the sensation of pain
  • Anti-inflammatory medications available in prescription-strength formulations
  • Antidepressants such as selective serotonin and norepinephrine reuptake inhibitors (Cymbalta®) and tricyclic antidepressants (amitriptyline)
  • Nonmedical treatments such as cognitive behavioral therapy, physical therapy, mindfulness training and biofeedback, and acupuncture

Breathing problems can develop urgently, and your doctor may stop medications that pose more harm than good. Ideally, most patients working with a physician can be taken off of medications in a controlled fashion to avoid withdrawal symptoms, Dr. Bolash says.

“Withdrawal from opioids is usually only uncomfortable for a few days, but there is no point in going through that if you can draw down the dose slowly,” he says.

Switching from opioids to other treatments works best when you’re motivated to make a change, Dr. Bolash says.

Work with your doctor to find something that works just as well, but keeps you breathing easily.

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