3 Questions to Ask Before Taking Prescription Pain Meds

Over the last few decades, the prevalence of narcotic painkiller (also referred to as opioids) use in the United States has skyrocketed. This class of medications suppresses the body’s perception of pain by blocking signals between the brain and the nervous system. In the past, usage of opioids for pain relief was mostly limited to short-term instances of severe pain, such as during the recovery period after surgery, a traumatic injury or an acute flare-up of an existing condition. Opioids are powerful and extremely effective at treating pain. But there are also risks associated with their use. In the short term, the tradeoff (risk vs. benefit) usually makes sense. The risks range from mild and nuisance-like to severe and include things like drowsiness, constipation, nausea and vomiting, itchy skin and even death (usually from respiratory suppression). But initiating prescriptions at low doses and providing warnings to avoid use of alcohol or other drugs that can interact with the opioids significantly reduces these risks.

There are significant benefits to managing acute pain. Gone unchecked, the pain can cause physiologic complications with cardiac, respiratory, autonomic, endocrine and inflammatory consequences. Surgical recovery is certainly aided by aggressive pain control. Patients regain the ability to move around and walk more quickly, get out of the hospital earlier, avoid disordered sleep and have a drastically improved quality of life with good pain control. In addition, for acute and short-term problems, patients are under a much more watchful eye (and are typically out of their usual daily routine). Opioids typically make sense for acute, short-term pain relief. The risks of long-term use of opioids for chronic pain include all the short-term risks plus the additional risks of overuse and addiction that can be devastating. Most physicians learned of the duality of opioid prescription during training (reasonable for acute pain; to be avoided for chronic pain). Most of us are also aware the studies showing the dangers of chronic opioid use are infrequently accompanied by benefits of improved function, performance or quality of life. But somewhere along the way, longer-term use of opioids, especially for those who suffer from chronic pain, became a much more prevalent reality, and with it came a host of serious problems.

For patients seeking relief from chronic pain, an initial prescription for an opioid medication can be the start of a dangerous cycle of addiction if not carefully monitored by a trusted and knowledgeable physician expert. Some patients’ pain is so intense and debilitating that relief can become the only goal, even if that means trading the life-disruptive pain for other disruptive side effects and complications. Treating the physical pain, for these patients, may mean knowingly increasing the dose and frequency of pills without regard for their doctor’s prescribed recommendation. In other cases, individuals may be “treating” depression, anxiety or insomnia with opioids (called misuse) rather than seeking appropriate treatment for these issues – because the opioid “numbs” them, gives them a high or makes them fall asleep. Still other scenarios involve individuals who, unknowingly, have genetic differences in how they metabolize medications, resulting in the need for dramatically higher doses of a medication to feel any pain relief effect. They may doctor shop or turn to street drugs because the prescribing physician is unaware of their peculiar physiologic state and refuses to give them appropriate treatment for acute pain, thereby exposing them to an increased risk of chronic pain or inappropriate combinations of medications and street drugs in search of pain relief. These additional side effects and unintended consequences can also include withdrawal from friends and family, poor work performance, malaise, apathy and, ultimately, addiction, as the body develops tolerance and begins to require increased doses of the drug for the same level of pain relief. All of this is just to mask the symptoms (pain) of a condition without focusing on the underlying cause.

As health care providers have begun to realize the consequences of opioid over-usage, more thorough protocols, deeper evaluation of a patient’s pain and long-term effects have become a greater focus. In some instances (for both acute and chronic conditions), prescribing opioids may still be beneficial, and prescribing doctors hold an immense responsibility to exercise judgment that will keep their patient free from harm, or in the worst cases of opioid addiction, death.

So what if you do end up on the receiving end of a narcotic prescription? The good news is that you as a patient can share in the role of keeping yourself safe and take control over your own health by staying educated and asking important questions. Before you begin taking a prescription for an opioid painkiller, receiving thorough answers to these questions will help you make the choice that’s safe and most appropriate for you.

1. Why am I being prescribed an opioid? (What is the goal and what is the endpoint?)The reason a physician would prescribe this type of medication should directly relate to the underlying cause of your pain and how the resulting pain is being classified. It is imperative that both you and your doctor understand what is causing the pain you're feeling. The last thing you want is to become dependent on pain medications for months or even years without resolution of the main issue that’s causing the pain in the first place. You may think this sounds like common sense, and you may even feel uncomfortable questioning your physician about his/her recommendations, but don’t be afraid to speak up. It's in your best interest to be firm in expressing that you don't wish to only cover up the pain, but that you desire an accurate diagnosis of the cause, too. Furthermore, you and your physician should understand that pain relief is only part of the goal. You should also be seeking significant improvement in function. If both aspects of the goal are not met, the use of an opioid isn’t justified. When both aspects of the goal are met, an effort should be made to reduce the dose and eliminate the opioid medication.
2. What are the risks of taking this medication? Before taking any medication, it’s vital to understand all the risks and benefits, but this is especially true with a more powerful drug such as an opioid. The general risks are important, but what can be most valuable is to ask the physician about the risks for you personally. Doing this requires your physician to have a detailed account of your medical history, including family history of addiction, mental health status, possibility of pregnancy or any other medications you're currently taking. Narcotic medication for short-term pain generally carries little risk, as it can be stopped before your body becomes tolerant of the medication. In some cases, genetic testing can be extremely valuable in predicting your response to specific opioid medications and dosing likely to be necessary for benefit without undue risk. Keep in mind, some risks are dependent on the duration of use. Long-term usage for chronic pain can put you at significant risk for many complications (cognitive, endocrine, etc.) in addition to dependence and addiction. Make sure you understand from your doctor how long you should be taking these drugs, and whether there's a stop date already planned.
3. Are there alternative treatment options? For most chronic pain patients, there are a number of effective treatment options – both pharmacologic and non-pharmacologic. In fact, multidisciplinary treatments have been proven beneficial for chronic pain. Importantly, they help both pain and function. Combinations of non-opioid medications, physical therapy and functional restoration, cognitive therapies, biofeedback, mindfulness meditation, interventional procedures and neuromodulation can dramatically reduce and eliminate pain while improving function and quality of life. Having a discussion with your doctor and expressing your willingness to try the non-narcotic treatment options first opens the door to other possibilities that may help you even more.