Why Opioids May Not Be Best for Your Chronic Pain

The powerful pain drugs are often ineffective long-term
Medicine Bottle and Pills Under Spot Light

Opioids— drugs like OxyContin® and Percocet® — are powerful painkillers. But opioids aren’t usually best for chronic pain. 

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“Today, pain specialists rarely prescribe opioids for chronic pain unless it’s cancer-related,” says Richard W. Rosenquist, MD, Chairman of Cleveland Clinic’s Department of Pain Management.

Lessons learned 

It wasn’t always that way. From late 1980s through early 2000s, physicians tried to improve the way they treated chronic pain by prescribing opioids for more people. They believed that by taking the highly addictive drugs only as prescribed, patients wouldn’t become addicted. This thinking was quickly proved wrong. 

“Reality caught up with us,” says Dr. Rosenquist. “Over the years, we learned that dependence on opioids develops quickly.”

The consequences have been making headlines ever since. Just a few examples include: 

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  • 15,000 to 18,000 U.S. deaths per year due to overdose of prescription opioids
  • “Pill mills,” or business that dispense opioids inappropriately for profit, quickly springing up (and later cracked down on) 
  • Growing rates of addiction to heroin. Why? This less-expensive opioid is commonly turned to by addicts  for cost reasons or when their pill mill gets shut down

Other downfalls

These powerful pain killers aren’t only highly addictive. Experts also learned that they:

  • Don’t provide adequate pain relief long-term. “After a while, patients are lucky to get 20 or 30 percent relief,” says Dr. Rosenquist. “Often, improvement in function and general well-being is even lower.”
  • Cause unwelcome side effects. Weakened immune system, hormone imbalances, respiratory depression, sedation and constipation are just a few. For some patients, opioids make their pain worse.

When are these drugs appropriate?

Opioids are best for treating short-term pain. For chronic pain, Cleveland Clinic physicians prescribe them only for cancer pain or when other treatments don’t work. Even then, they’re used only in low doses. Plus, they are continued only if the patient’s function (not just their level of pain) improves.

If you’ve taken opioids long-term

If you’ve taken these pain killers for a long time, see a pain management specialist. He or she can re-evaluate the cause of your pain.

“If you were taking antibiotics for a urinary tract infection but your infection wasn’t going away, you’d stop using the antibiotics and try something else,” says Dr. Rosenquist. “The same is true with opioids and chronic pain.”

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Pain management specialists can offer an array of other more potentially successful treatments — with fewer side effects.

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