The Painkiller Dilemma

By Jacob Blake, MD

Prescription painkillers are powerful drugs that reduce pain by interfering with the nervous system’s ability to transmit pain signals. Most painkillers also stimulate portions of the brain associated with pleasure so that in addition to blocking pain, they produce a high.

The most powerful prescription painkillers are called opioids. These drugs produce a short-lived euphoria but because they are addictive, their long-term use can lead to physical dependence. The body adapts to the presence of the substance and if drug use stops abruptly, withdrawal symptoms occur. The body could also build up a tolerance to the drug, meaning that higher doses must be taken to achieve the same pain relief effects.

Despite an enormous focus on the clinical use of opioid analgesics, the topic is still quite controversial. There are those within the medical community who would argue that physicians should stop prescribing opioids in chronic pain patients because of the rise in opioid overdoses during the last 10 years. Those on the other side of the argument seek to preserve the right of patients in chronic pain to live with less suffering.

History behind the use of opioids

Opioids have been used for thousands of years to control pain, with their first use in the form of opium until morphine was developed in 1803. After the hypodermic needle was invented, morphine was widely used to treat soldiers with painful traumatic injuries. In the 1890s, Bayer AG, the inventor of aspirin, developed heroin and briefly promoted it as a less addictive pain pill until it was found to be highly addictive and made illegal.

A movement in the 1960s to increase the accessibility of pain medications was sparked by the lack of pain control options for cancer patients. In the 1990s, multiple synthetic medications with short- and long-acting profiles were created. Sales of opioids quadrupled between 1999 and 2010. Physicians used these compounds more abundantly with chronic pain patients. Oxycontin became a household name. The rise in deaths associated with these medications followed. Prescription opioid deaths have become too common.

Do they work for chronic pain and should they be available?

Unfortunately, the answer is both yes and no. The data for long-term opioid therapy relies mostly on short-term studies that usually last only 90 days. There is a lack of long-term data that shows whether or not continuing use results in higher functional status or less disability among patients who suffer from chronic pain. Conversely, anecdotal experience tells us that there are many patients who use opioids appropriately and report significant improvements in these parameters. They seem to help ease pain and suffering in many patients who have already tried and failed more conservative treatments.

Physicians who specialize in pain management are charged with the difficult task of assessing the risk of every patient for potential diversion, abuse or addiction in the same breath that they offer up hope and compassion. Based on the risk level and condition, physicians must determine whether these medications are the right treatment for a patient in chronic pain. As a patient, you must trust that your physician will make the right choice for you.

To alter the course of this opioid epidemic it will take a combination of using more alternatives and delicately choosing which patients are the right candidates for these drugs. The hope is that we will find an area in the middle where prescription opioids will be available when desperately needed, but are safely kept out of the hands of those who might succumb to them.

Learn more about the Pain Management Center at Northern Nevada Medical Center.