As an Interventional Pain Management specialist, I work to alleviate chronic pain of all types, using minimally-invasive techniques designed to diagnose and treat the underlying cause of painful conditions. In the Interventional Pain Management department at OSC, we offer a wide range of in-office procedures which are done in our fluoroscopy suites. We perform epidural steroid injections, spinal cord stimulation and radiofrequency ablation, among many other treatments. Additionally we may need to manage pain with medications. There are many classes of medications used to treat pain and not all are narcotics. For some patients opiate pain medications may be necessary. We try to avoid these medications when possible because of very serious side effects however they can be effective and are appropriate in some circumstances.
Opioid medications are commonly used to treat acute pain. Examples include morphine and oxycodone. Because they have psychoactive properties they may be misused and abused. They can produce a high, rush, or a feeling of euphoria. People who abuse them usually take them more frequently and at a higher dose than recommended. These medications have addictive qualities, so we take our prescribing responsibility very seriously. When used long term for chronic pain, treatment requires regular office visits which may include urine drug screens to verify safe medication use.
When we ingest an opioid, it goes into action by attaching to specific proteins in the body called opioid receptors. These receptors are located throughout the body in various organs, including the brain, gastrointestinal tract, spinal cord and other areas. The opioid reduces the intensity of pain signals reaching the brain, thereby decreasing the perception of pain.
These medications do have very strong pain-relieving properties, so when used properly, can have a positive effect on a person’s life and wellbeing. Unfortunately, in addition to these pain-relieving capabilities, opioids have a long list of unwelcome side effects. Below is a list of some potential side effects of opioid medications – this list is not comprehensive and many patients experience side-effects not outlined here. Most of these begin when people start taking the medication or increase the dose, and patients can take some action to lessen their severity.
1. Constipation – Unfortunately, this is so common that it has its own name: Opioid-Induced Constipation. If you do suffer from constipation, it will probably not go away while you are on the medication. Just about everyone who takes opioids will have some degree of constipation. Opioid receptors in the bowels react by slowing down the action of the bowel muscles, which will cause the bowels to hold waste for a longer period of time. I encourage patients to increase their dietary fiber and water intake and take a laxative or stool softener as necessary while taking opioids.
2. Nausea – There are opioid receptors in the chemoreceptor trigger zone (CTZ) of the brain. This area communicates with the brain’s vomiting center. Another reason for nausea is the same reason for constipation: opioids slow down the movement of food and fluids through the stomach, causing nausea and vomiting.
3. Drowsiness – This generally occurs when a patient initially begins the medication or after an increase in dose. Avoid activities like operating heavy machinery or driving until the drowsiness subsides.
4. Confusion – As I previously mentioned, opioids are psychoactive drugs, which means they act on the central nervous system. This affects brain function and can cause alterations in perception, mood, and behaviors. When patients begin taking a new medication or increase the dose, it is common to feel confusion or mental cloudiness. If this feeling continues, we may need to decrease the dose.
5. Itching – A small percentage of opioid users may experience widespread itching, known as pruritus. Many patients who experience this think they are having an allergic reaction to the medication, but that is very rare. This side-effect may subside with time or with the use of an antihistamine.
6. Breathing Problems – When you take an opioid medication, your body’s regulation of breathing can be diminished because of the way the respiratory centers in the brain stem react to the medication. This is one reason that we start patients on a low dose and increase slowly if necessary. If a person takes too high of a dose they can stop breathing. This can lead to serious injury and death, therefore you should never take a higher dose of an opiate pain medication than prescribed.
7. Addiction – The risk of addiction to your pain medications is statistically low, but unfortunately does occur. People with a personal or family history of alcohol or substance abuse are at increased risk. We ask that patients be open about their history because we are here to help them and do our best to make sure they do not harm themselves.
I strongly encourage my patients to visit me regularly, so together we can be sure they feel in control of their pain. It is my hope that my patients feel they are part of the team working to control their own pain. If you could benefit from a consultation with an Interventional Pain Management specialist, please call OSC and make an appointment.
Jenny L. F. Andrus, MD, is a Fellowship-trained, Board-Certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Named a Coastal Virginia Magazine’s “Top Doc” for 2014, Dr. Andrus joined OSC in 2009. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com. For an appointment, call 757-596-1900