17 November 2017
Will opioids work to treat my pain?
Opioids have traditionally been used to treat both acute and chronic pain. Opioids are very effective in treating moderate to severe acute pain. However research shows that opioids are generally non effective in treating chronic non-cancer pain, and in some cases can actually make the pain worse.
So pain killers can make my pain worse?
Yes, opioid induced hyperalgesia is a condition where opioid pain medications create more pain rather than pain relief. Patients who have opioid induced hyperalgesia may have:
• Increased sensitivity to painful and non-painful stimuli.
• Worsening pain despite increasing doses of opioids.
• Decreased pain threshold.
• Pain that becomes more spread out, extending beyond the area of usual pain.
Why all the fuss?
At least three Australians die every day from overdose, and the majority include common prescription medications used to treat chronic pain such as opioids and benzodiazepines. While there has been considerable interest in addressing the issue of alcohol and illicit drugs, little has been done to increase community education in ensuring the safe and appropriate use of prescription medications. The Australian Medical Association (AMA) called prescription drug abuse a “national emergency”.
Well known Australian actor Heath Ledger tragically died of a drug overdose. The prescription medications that were responsible for this tragic event are some of the same medications that are prescribed for chronic pain. His father Kim has since become the Patron for Script Wise, a not-for-profit organisation helping raise awareness for safe use of prescription medication.
In 2015 rugby league players Dylan Walker & Aaron Gray overdosed on what is colloquially known as Hillbilly Heroin, following post season surgeries. The pair were in critical conditions and were lucky to survive this scary incident. The medical name for the substance is Oxycodone or Endone. Once again, this is a drug commonly prescribed for relief of chronic pain.
What is chronic pain? Chronic pain is pain that lasts longer than 3 months. In many cases, this means that pain continues even after the injury or condition that first caused it has been treated.
What causes chronic pain? The cause of chronic pain is not always clear. Sometimes it is caused by an ongoing medical problem, such as arthritis or diabetic nerve damage. But doctors cannot always find the cause of chronic pain. In some cases, people with chronic pain must accept that their pain will never be explained. This does not mean that they have to accept their pain. It just means that they have to work with their healthcare team to address the pain, even if they don't know its cause.
How is chronic pain treated?
Chronic pain is generally treated with a combination of therapies including both medications and non-medication therapies
• Simple pain killers: paracetamol, ibuprofen (nurofen, voltaren)
• Stronger pain killers: Opiods (Codeine, oxycodone (endone, oxycontin), morphine, fentanyl)
• Other medications: anti-seizure medications (benzodiazapines, pregabalin, gabapentin), anti-depressants
• Nerve Blocks: Injections (shots) of numbing or pain-relieving medicines into the spine or area with pain
• Therapies to improve sleep or mood
• Physical therapy to learn exercises and stretches
• Relaxation, massage, acupuncture
• Working with a counselor
• Devices that affect nerve signals (TENS)
How do I find the best treatment for me?
• Be open to trying new treatments and combinations of treatments. Sometimes you have to try a few different options before you find one that works best.
• Set realistic goals for your treatment. Even if you can't completely get rid of your pain, you might be able to control it enough so that you can do the things you want to do.
If your doctor suggests a medicine that seems out of place, keep an open mind. Sometimes, doctors treat pain with medicines made to treat other medical problems. For example, doctors can use medicines for depression to treat pain because they work on areas of the brain that process pain. Doctors can also use medicines for seizures to treat pain, because they help with overactive nerves.
Is there anything I can do on my own to feel better?
Yes. Some things to try include:
• Use a heating pad or a cold pack on the painful area
• Practice relaxing. You can learn methods to relax your body, such as doing deep breathing exercises. Relaxing the mind can help with how the body feels pain.
• Stay as active as possible. Walking, swimming, tai chi (a kind of martial art), or biking can all help ease muscle and joint pain. If you are not active, your pain might get worse.
• If you feel depressed, talk to your doctor or nurse about it. Chronic pain and depression often go together.
We recommend that you talk with your doctor prior to commencing any of the above therapies
How can the team at Grand Pacific Heath Centre help me?
Your GP is a great place to start. Your GP is best placed to manage the services you require to treat your chronic pain. The services of certain health professionals such as a physiotherapist or clinical psychologist may be accessed through something called a ‘care plan’ which may allow for some of your consultations to be covered by Medicare.
Your doctor will advise if you are eligible for a care plan and can coordinate this, starting by putting down on paper what services you may need, treatment goals, and how you are going to manage in the future. Medicare may cover some or all of the consultation costs of up to five visits per year with certain health professionals, such as a physiotherapist and up to ten consultations per year with a clinical psychologist if you have depression and/or anxiety.
The Opioid/Benzodiazepine Contract:
If you and your doctor decide that either opioid or benzodiazepines are the appropriate medication for you, you may be required to commit to a contract. This contract is an agreement between you and your doctor that sets treatment goals and facilitates the safe and appropriate use of these medications.
Further information on chronic pain http://www.painaustralia.org.au/images/pain_australia/PainAust_FactSheet7_Jan_16.pdf
Pain made worse by opioids (Opioid Induced Hyperalgesia)