Why opioids are not the solution to pain

Why opioids are not the solution to pain

Make no mistake about it, there are situations where painkillers like oxycodone and morphine are the best choice. Doctors give these opioids for a wide range of reasons and they are completely appropriate after many operations, dental procedures, certain injuries and to treat the pain associated with cancer.

But opioids are dangerous for several reasons. The most obvious is the propensity for addiction. Opioids contain synthetic versions of chemicals found in the poppy plant – they relax the body and can relieve pain, but at the same time this can cause euphoria.

Some people may become addicted to these sensations within just a few doses – and without exception, chronic users of opioids require ever-increasing doses to achieve an effect. The use of opioids, particularly in the US and the UK, is approaching epidemic proportions.

Side effects include cognitive deterioration and confusion, gastro-intestinal upset and constipation, insomnia, blurred vision, difficulty urinating and erectile dysfunction. And if you stop taking them after long-term there is an extremely unpleasant post-withdrawal syndrome. But worst of all, opioids also depress respiratory drive – in other words they affect your ability to breathe. And this can cause death.

In order to avoid taking opioids other than when truly necessary, it helps to understand a bit more about the type of pain you are dealing with. Doctors characterise pain by the system that is generating the signal.

• Visceral pain is caused by a problem in the inner organs of the body such as the heart or bowels. This type of pain is often deep and gnawing in character and it responds very well to a course of opioid painkillers.

• Somatic pain arises from the outer layers of the body [skin, tissue, muscle] and while opioids can occasionally help with this type of pain, there are often better choices than opioids.

• Neuropathic pain is pain arising from a nerve or group of nerves. It has a different character to the other types of pain and while neuropathic pain can be excruciating in some cases, opioids are almost never the right choice of medication.

Regardless of the type of pain, doctors generally stick to a step-wise approach to pain relief where lower-impact medications are used first before moving to more and more hard-hitting options such as opioids.

Paracetamol is a very underrated painkiller, and it really comes down to how it’s taken, with the effectiveness increasing massively if you take it strictly four times a day when required. Another option is ibuprofen, which is excellent as an anti-inflammatory, but only recommended for short periods due to its potential for harm to the stomach and kidneys.

Increasingly, people (and their doctors) are turning to non-pharmacological remedies for pain relief. Particularly for back and arthritic pain, which are among the most common reasons for going to the GP, I always recommend a combination of gentle stretching, Pilates and yoga – they increase strength, flexibility and mobility while decreasing the perception of pain.

Some people find TENS (trans-epithelial nerve stimulators) to be quite effective, and these machines are cheap and easily accessible.

In terms of natural supplements, there is very good evidence for the use of curcumin, omega-3 fatty acids, glucosamine, CBD oil and even magnesium.

Lifestyle can play a massive role in easing pain. Diet in particular, and the reduction of pro-inflammatory foods such as processed carbohydrates, is extremely effective in both reducing weight and reducing pain. Equally, adequate sleep is another factor that, over time, has a beneficial effect.

My other universal lifestyle intervention for those that are experiencing pain is, believe it or not, meditation. It can take a long time and dedication, but it is definitely worth it. There are loads of great apps to help you like Waking Up, Headspace and 10% Happier.

Mindfulness meditation reduces the suffering a person experiences in association with physical pain.

That’s because a major part of pain-related suffering is actually due to the worry that the pain will continue into the future. Mindfulness by definition is experiencing the present and in this way skilled meditators are able to avoid or greatly reduce suffering.

While opioids can be extremely useful and effective painkillers, it is important to explore all the other options first.

Dr Harrison Weisinger is family doctor and university professor who lectures and publishes papers on topics such as nutrition and neural development. He is scientific adviser for the supplement company Truth Origins. 

Pain checklist:

1) Find out what is causing the pain
2) Consider all other options before taking opioids
3) Avoid inflammatory foods such as processed carbohydrates
4) Try to maintain a healthy weight
5) Natural Supplements like curcumin, omega-3s and CBD oil can help
6) Make sure you are getting enough sleep
7) Do restorative exercise like yoga
8) Meditate

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