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Opiates for Chronic Pain


Opiate, according to Merriam Webster Medical Dictionary is "a preparation (as morphine, heroin, and codeine) containing or derived from opium and tending to induce sleep and to alleviate pain." Although they've been used for 6,000 years, the role of opiates in pain management is much debated today. 

The role of opioid therapy in the treatment of noncancer pain has been very controversial due to the limited number of clinical trials validating this approach and the understandable concerns of doctors who worry about causing more harm than good. Physicians also have to worry about regulatory oversight by law enforcement officials. Many doctors and even patients fear that the patient will become addicted to the medication. However physical dependence is not the same as addiction. Addicts take drugs to achieve a "high." Those in severe pain many times take it just to be able to function. Unlike an addict, the typical pain patient experiences little or no euphoria from narcotics. Because the effectiveness of pain medication varies greatly from person to person, a patient's need for a high dose is not necessarily a sign of addiction. 

Luckily for us, things are slowly changing. More and more doctors are using opiates for chronic musculoskeletal pain. Studies are being done and they are showing that the actual addiction rate is very low in those with chronic pain. In one study, only four cases of addiction were found among 11,882 hospitalized patients with no history of addiction receiving opiates. Only one of those four cases was considered major. Another study done at Johns Hopkins Pain Treatment Center showed that in noncancer patients experiencing chronic pain, treatment with long-acting opioids significantly decreased pain intensity, anxiety, hostility, and sleep problems. They did not experience any cognitive declines, in fact treated patients improved on one measure of sustained attention and psychomotor speed. 

The regulations are changing also. A number of state medical boards have developed guidelines for the prescribing of controlled substances for pain. In most cases, the purpose of these guidelines has been to clarify that the board accepts that opioids may be used to manage chronic noncancer pain and to outline the board's basic expectations of the doctors who prescribe them. 

What does all this mean for us? Hopefully better pain control is in our future. Combined with other pain management therapies, opiates can be a valuable tool in allowing those with chronic pain to have a better quality of life. 



References:
1997 Joranson DE, Gilson AM. State Intractable Pain Policy: Current Status. APS Bulletin, 7(2):7-9.

State Intractable Pain Policy: Current Status, David E Joranson, MSSW, Aaron M. Gilson, MS MSSW

NEUROLOGY NETWORK COMMENTARY, 2:175-179,1998, Opioids for Chronic Pain: The Issue Is Efficacy, Not Addiction, Outcome of Chronic Opioid Therapy for Non-Cancer Pain, Article by Jennifer A. Haythornthwaite, Ph.D.,* Lynette A. Menefee, Ph.D., Amy L. Quatrano-Piacentini, B.A., and Marco Pappagallo, M.D. J Pain Symptom Manage 1998;15:185-194

Chronic pain
Reassessing the role of morphine and other narcotics
October 10 1997 Mayo Clinic Health Oasis

The Painful Dilemma
The Use of Narcotics for the Treatment of Chronic Pain 
A report prepared by the SACRAMENTO-EL DORADO MEDICAL SOCIETY ad hoc committee on the treatment of pain - 1990