Wake Spine and Pain Specialists Opioid Therapy Statement
As part of a comprehensive pain management plan, Wake Spine and Pain Specialists will sometimes utilize prescription opioids for pain relief. Opioids are a class of narcotic drugs that are derived from morphine. They work with opioid receptors by disrupting pain signals sent to the brain by the nervous system. In this way, opioids can offer pain relief.
The most commonly prescribed opioids are:
- Oxycodone (OxyContin)
- Fentanyl (Duragesic)
- Hydromorphone (Dilaudid)
When combined with acetaminophen, hydrocodone and oxycodone are prescribed under the brand names Vicodin and Percocet.
Opioids are available in pills, liquids, suckers (lollipops), shots, skin patches, and suppositories.
In general, opioids are most effectively prescribed for short-term, episodic pain relief from injury or illness. Conditions for which opioids may be prescribed include:
- Back pain: This includes degenerative disc disease, ruptured or herniated disc, spinal stenosis, and vertebral compression fractures
- Hip pain: Osteoarthritis and fracture are the most common injuries treated with opioids
- Daily, recurring headache: Migraine and tension headaches
- Cancer pain: Especially in late-stage cancer patients
- Neuropathy: Including diabetic neuropathy and any other type of nerve pain
- Inflammatory bowel disease: Crohn’s disease and ulcerative colitis
- Surgical procedures
While some patients benefit tremendously from opioid therapy, recent research into the effectiveness of opioids on chronic pain has shown that opioids may do more harm than good when it comes to treating chronic pain.
In 2015, a meta-analysis by the National Institute of Health looked at existing studies regarding the effectiveness of opioids for long-term chronic pain and found no evidence that opioids were effective at treating long-term pain. This same meta-analysis found evidence that indicated a high risk of dose-dependent, serious side effects.
These side effects include:
- Increased risk of opioid abuse and dependence
- Bone fracture
- Myocardial infarction
Abuse and dependence are a major potential side effect of prescription opioids. As of 2014, an estimated 1.9 million people in the U.S. had a substance abuse disorder involving prescription opioids. From 1999 to 2008, opioid addiction rates and opioid prescription rates rose in parallel, with the death rate from overdose increasing 400% during the same period. Opioids are powerful narcotics that change the structure of the brain such that it adapts to the dose and gradually requires more to feel the same pain relief. Even when taken as directed, long-term use can result in dependence.
Opioid-induced hyperalgesia, or increased pain sensitivity, is also a possibility with long-term use of opioids for chronic pain. Previously, opioid-induced hyperalgesia was thought to be a byproduct of opioid withdrawal, but new research has shown that it can occur at any stage of opioid administration.
Other lesser-known of side effects of long-term opioid use can include:
- Immunosuppresion: Long-term use of opioids can suppress the body’s immune response, making patients more vulnerable to other health issues. This can be especially difficult for those pain patients with other chronic, immune-related illness.
- Decreased libido: For men, long-term opioid use can result in lower levels of testosterone production (hypogonadism). In women, this same long-term use can disrupt hormone production, causing amenorrhea (lack of menstrual cycle). In both cases, this can result in a decreased sex drive.
- Osteoporosis: Opioids have been shown to raise the risk of developing osteoporosis in both men and women.
At Wake Spine and Pain Specialists, we believe that the risks associated with long-term opioid use warrant caution and restraint when it comes to prescribing these medications. Our pain management specialists focus on comprehensive pain diagnosis and management. To that end, we look to a host of other treatments before prescribing opioids.
Conventional treatments may include prescription non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and steroids. We may also look towards minimally-invasive procedures, such as nerve block procedures, or more invasive techniques such as viscosupplementation, spinal cord stimulation, intrathecal pain pumps, or radiofrequency ablation.
Our pain management specialists believe in a holistic approach to chronic pain and also offer many complementary and alternative options for pain relief. These may include:
- Chiropractic care
- Physical therapy
- Massage therapy
- Hyperbaric oxygen
- Psychological and behavior interventions
- Biofeedback and hypnosis
- Fear avoidance training
While we strive to exhaust all other pain-relieving options prior to prescribing opioids, we recognize that for some patients in specific circumstances, opioids may be their best option for relief. Wake Spine and Pain Specialists follows strict prescribing and monitoring guidelines as set forth by the federal government and works closely with patients to resolve their pain in other ways before utilizing opioids.
Part of working closely with our patients includes discussing and signing an opioid agreement form. This form follows the Centers for Disease Control’s updated opioid prescribing guidelines and includes the following provisions:
- The agreement acknowledges that opioid therapy is just one part of a patient’s comprehensive treatment plan.
- Patients are to follow all parts of the holistic, comprehensive pain management plan designed with their doctors to include a number of different therapies. This may mean making lifestyle changes as well as undergoing counseling and other complementary therapies tailored to each individual patient.
- Doctors prescribe the lowest effective dose and will not increase the dose without thoroughly re-evaluating the patient.
- Patients agree to regular follow-up visits, urine screenings within 24 hours, and pill counts if requested by their doctor.
- Doctors and patients will work closely together with all other specialists and physicians to avoid over prescription or concurrent benzodiazepine or opioid prescriptions.
Each part of this opioid agreement form was designed to protect the patient while they are undergoing opioid therapy.
Our goal at Wake Spine and Pain Specialists is to develop the best possible pain management plan for every patient that improves their quality of life. We work as a pain relief team to provide comprehensive diagnostic and therapeutic services at each of our locations. We utilize an extensive array of treatment options specifically designed for each patient. When one of these options is opioid therapy, we provide the support and guidance needed for safe, effective pain relief.
For more information on all of our pain management options, including opioid therapy, please call to schedule an appointment at the office nearest you.