Finding the Right Balance in Potent Pain Medication Therapy

Your pain management specialist will identify the pain you’re experiencing and the treatment that is best for you. Typically, your doctor will try alternative treatment options to help relieve your pain before prescribing medications, especially narcotics.

Types of Pain Medications

There are a variety of medications available to help patients find relief from acute and chronic pain. These categories include anti-inflammatory medications, muscle relaxants, antidepressants, anticonvulsants, and lastly analgesics. The primary function of analgesics is to relieve pain and they are divided into two subgroups.

Over-the-Counter Medicines: These are also known as OTC medications. These medications provide pain relief and do not require a prescription. These medications fall into two categories

• Acetaminophen: Acetaminophen is a pain reliever and fever reducer. It chemically blocks pain receptor signals in your body so you feel less pain. It also helps reduce fevers by helping your body eliminate excess heat. One of the most common Acetaminophen medications is Tylenol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs block the body’s production of the enzymes that are responsible for inflammation and pain. The most common NSAID medications are Aspirin and Ibuprofen.

Prescription Opioids: These potent pain medications are also known as narcotics or painkillers. Opioids are a class of drugs used to relieve severe pain but require a prescription from a doctor. These work via the central nervous system by attaching to proteins called opioid receptors, which are located on nerve cells in the brain, spinal cord, and gastrointestinal tract. By doing this, they block pain signals from being sent to the brain. They also cause the release of dopamine, a neurotransmitter that produces feelings of pleasure, which can make the person feel better overall. In addition, they can reduce inflammation, which can help reduce pain. Some of the most common ones are:

• Oxycodone (OxyContin)
• Hydrocodone (Vicodin)
• Codeine
• Fentanyl
• Morphine

When considering whether or not to prescribe opioids, doctors consider the severity of the patient’s pain, duration of pain, and if there are any non-opioid options available that have yet to be pursued. In addition to analyzing the pain a patient is enduring, doctors will consider medical history, the patient’s lifestyle, and if there is any history of mental health concerns or substance abuse.

Harmful Effects of Opioids

Opioids have proven to be more effective than non-opioid analgesics for many patients with severe and ongoing pain, but they are not without downsides.

Physical Dependence: Opioids are highly addictive and can lead to physical dependence and tolerance, meaning you need higher doses to get the same effects and experience withdrawal symptoms when not taking the drug. Physical dependence can lead to Opioid Use Disorder (OUD), which is a condition where individuals have difficulty controlling their use of opioids.

Respiratory Depression: Opioids can cause respiratory depression, or shallow breathing, which can be dangerous or even fatal.

Side Effects: Opioids can cause nausea, vomiting, constipation, dry mouth, confusion, depression, and even hallucinations.

Overdose: Taking too much of a prescribed opioid or mixing it with alcohol or other medications can lead to an overdose, which can be fatal.

Minimizing the Risk of an Opioid Emergency

If opioids are deemed necessary, patients must ensure their healthcare provider is aware of their full medical history, any current conditions they have, and the medications they are taking. Together, you can formulate a plan to minimize your risk of experiencing a respiratory event.

• Ensure you are following your provider’s directions for the medication. Do not take greater amounts more often than prescribed.
• Avoid mixing opioids with alcohol or other medications
• Always alert your doctor of any side effects you experience

Additionally, if your provider prescribes Naloxone, have it filled and make sure both you and those close to you understand when and how to utilize it. Your doctor and pharmacist should educate you regarding appropriate use. Be sure you ask questions because understanding how to recognize the signs and symptoms of respiratory depression is vital.

Naloxone

Naloxone is also known as Narcan®, which is used to rapidly reverse an opioid overdose. It works by blocking the effects of opioids on the brain and rapidly restoring normal respiration to someone whose breathing has slowed or stopped as a result of an overdose. It does this by temporarily binding to the same opioid receptors in the brain as the opioids themselves; however, it is stronger than opioids and can overpower them.

Think of Naloxone (Narcan, Evzio), as someone with a severe allergy would think of an Epi-Pen. If you are allergic to bees, you don’t stop going outdoors. Instead, you simply prepare for the possibility that experiencing the outdoors could lead to harm. As a patient taking an opioid, you are at higher risk for a dangerous respiratory event, and Naloxone is meant to provide a means of rescue should you experience opioid-induced respiratory depression.

Opioid-Induced Respiratory Events

What Is an Opioid-Induced Respiratory Depression?

Opioid medications act on areas in the brain to decrease your subconscious drive to breathe. When taken in large quantities, such as an overdose, they can lead to extreme sedation, unconsciousness, severely slowed breathing and even death. Unfortunately, even when taken as prescribed, opioids may affect your breathing. This is particularly true when taken in higher doses, and when you have other medical conditions that may affect your breathing, such as COPD, asthma, sleep apnea, or a respiratory infection. Also, alcohol consumption and the use of other sedating medications increase your risk. Medications called Benzodiazepines (Valium, Xanax, Ativan, etc) are of particular concern and, if possible, should be avoided when taking opioids.

How to Identify a Respiratory Event

The most common early sign is sedation. If you feel that you are experiencing excessive or increasing sedation, avoid taking additional medication and call your provider or 911 for help. Those close to you must be able to recognize more advanced signs and symptoms if you are incapacitated. The World Health Organization identifies the three following signs, known as the opioid overdose triad, as key factors in identifying an opioid overdose:

• Slowed breathing
• Pinpoint pupils
• Unconsciousness

Additional signs and symptoms include unresponsiveness to stimuli, awake but unable to talk, pale or clammy face, vomiting, blue fingernails/lips, slowed pulse, limp body, and choking or snoring-like gurgling noises.

Dr. Peter Staats Helps Find the Right Balance in Potent Pain Medication Therapies

Recognized as one of the nation’s preeminent interventional pain management physicians, NSPC affiliated provider Dr. Peter Staats founded the division of Pain Medicine in the Department of Anesthesia at Johns Hopkins University, where he served as the director for more than a decade. Dr. Staats has written nearly 300 articles, book chapters, and abstracts on the diagnosis and management of complex pain problems for prominent publications such as JAMA, Lancet, Anesthesiology, Pain Medicine, and others.

Currently, Dr. Staats serves as the Chief Medical Officer for National Spine & Pain Centers and helps ensure that NSPC’s network of practices is providing the best treatment options to patients, while also ensuring we are keeping their well-being at the forefront of our care.

Want to learn more about our affiliated physicians and their viewpoint on prescribing potent pain medications responsibly to patients? Read the article here.

Seek Care Today!

There is not a one size fits all treatment for pain relief so you will need to consult with your pain management specialist to determine the treatment plan that best suits your needs.

Take control of your pain and schedule a consultation for a better, more pain-free future today. Reach out to an NSPC-affiliated physician today!