Since the 1990s, the use and misuse of prescription painkillers has been on the rise in the United States. In a 2010 report from the nonprofit organization National Survey on Drug Use and Health, Oklahoma had the highest rate of nonmedical use of painkillers nationwide, with more than eight percent of the population aged 12 and older abusing or misusing painkillers. Now, prescription painkillers are the most common class of drug involved in overdose deaths in Oklahoma.
So, why are painkillers prescribed at a higher rate than ever? Unfortunately, the need for painkillers is on the rise as well. There are approximately 100 million Americans suffering from chronic pain – that’s more than the number of people affected by diabetes, heart disease and cancer combined.
For people with acute pain, caused by an injury, trauma or surgery, a prescription for pain medication in conjunction with rest and physical therapy is common. Pain medications pose less of a risk of addiction for acute pain, because it’s prescribed for short-term use while the patient recovers and rehabilitates.
However, people with chronic pain face a serious decision when considering a long-term pain medication plan. “We really have to think hard about whether a long-term narcotic is appropriate for the patient, and we want to make sure we’ve tried other therapies,” medical director of INTEGRIS Pain Management Clinic, Dr. Atul Walia, D.O., says.
While pain medications can have serious side effects and risks, especially with long-term use, for patients with chronic pain, a narcotic may be necessary to achieve a functional quality of life. If you are suffering from chronic pain, and have reached a point in your treatment where a narcotic might be an appropriate option, you should know what questions to ask your doctor before starting treatment.
Questions to Ask Your Doctor
Below is a list of questions you should ask your doctor before going on a long-term pain medication. Discussing these questions and concerns with your doctor is crucial to making an informed decision regarding your treatment plan, potential risks, and how your medication may affect your daily life. “Always make sure you feel completely informed about how to use a new medication,” Dr. Walia recommends.
1. What other therapies are available, and is a long-term narcotic the appropriate next step?
While narcotic pain medications are an effective treatment for many chronic pain sufferers, medication shouldn’t be the only component of a long-term pain management plan. In fact, in many cases a doctor should exhaust a variety of other therapy option before prescribing narcotics. According to Dr. Walia, these therapies can include physical therapy, acupuncture, massage, bio-feedback and interventional therapies like nerve blocks, oblations and neuromodulation.
In certain cases of extremely severe pain, cancer treatment or end-of-life therapy, it may be appropriate to prescribe a pain medication without exhausting other options first. Each situation is different. Make sure you talk to your doctor about all available options in order to make an informed decision about whether narcotics are an appropriate next step for your therapy plan.
2. Should I seek a second opinion?
It may seem rude to ask for a second opinion when you already have a pain management doctor. However, going on a long-term pain medication is a big decision—one that you should feel completely informed and certain about. If you are aware of an alternative treatment or procedure that your current doctor does not perform, ask your doctor to help you get in contact with a specialist who can give you a second opinion. The specialist may be able to perform a procedure that can target the source of your pain, rather than treating your symptoms.
While a second opinion may not result in new information, it can provide reassurance that you are on the right pain management plan. If seeking a second opinion will give you peace of mind in your decision to start a long-term pain medication, you should bring it up with your doctor.
3. Is this drug safe for me, and how should I use it safely?
There are many factors that can affect whether a drug is safe for you. These include pre-existing health conditions, other medications, history of addiction or substance abuse, depression and psychological disorders. Dr. Walia recommends that people with respiratory, kidney, liver, or heart issues be very careful when considering a long-term pain medication, as these can lead to serious health complications or even death. Always discuss your concerns with your doctor, and know how to take your medication in a way that is safe for you.
4. How will this medication affect my daily function and quality of life?
Narcotic pain medications can have serious side effects that may impact your daily quality of life. It’s important to know potential side effects so you can recognize them when they occur. Common side effects of painkillers include constipation, drowsiness, dizziness, addiction, abdominal pain, nausea and vomiting. Dr. Walia also recommends having a close support system of people who can recognize negative side effects and warning signs of addiction, in case you are unable to recognize them in yourself.
Narcotics can also have negative effects on your lifestyle. Patients are required to schedule monthly check-in appointments. These additional appointments can be expensive, in addition to the cost of the actual medication. Furthermore, Dr. Walia suggests the CDC may continue to limit access to narcotics in the future, making it more difficult for patients to obtain medication. Patients should keep in mind that their current medication may become harder to obtain in the future.
5. What are the biggest long-term risks of using this medication?
While short-term use of narcotics is typically safe, long-term narcotic use can have serious effects on the body. These include sleep apnea, constipation and bowel dysfunction, opioid-induced hyperalgesia (abnormally heightened sensitivity to pain), dry mouth, tolerance, addiction and kidney and liver damage.
“A lot of narcotics are prescribed as needed,” Dr. Walia says. It can be easy to fall into the rhythm of taking a pill every six hours. However, it’s important to take pain medications as directed, which means pausing to assess your pain levels before each dose, to determine if you are taking a pill because it’s been six hours, or because your pain level warrants a dose. Taking painkillers strictly as needed can help prevent long-term health risks like tolerance or addiction.
Each patient situation is different. Therefore, finding the right pain management plan is a nuanced task for both patients and doctors to work through together. Long-term pain medications are just one piece of a complex system to help chronic pain sufferers achieve higher daily function and alleviate pain. Before going on a long-term pain medication, make sure you are informed on how to take your medication safely, what the potential risks are, how the medication may affect your life and what other therapies are available to use in conjunction with your medication plan.
For more details on narcotic prescriptions, consult Oklahoma’s Opioid Prescribing Guidelines.