We have a long and complex relationship with opioids. Humans have been actively growing poppies and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the ‘joy plant’.
However, we now know that while these medicines can provide significant pain relief when used appropriately, they can also cause great harm.
Did you know that every day in Australia, nearly 150 people are hospitalised, and 3 people die due to issues related to opioid use? (1)
That’s why in 2020, the Australian Government made changes to how we use and access opioids.
Opioids are pain-relieving medicines that come in various formulations, dosages and strengths. They include tramadol, codeine, morphine, oxycodone and fentanyl.
There are two groups of opioids:
Opioids can be taken as tablets, injections or patches on the skin.
Opioids attach to opioid receptors in the nervous system and slow down the messages between the body and brain, including pain messages. This dulls your perception of pain – it’s not gone, nor is the cause of the pain. It’s simply been dampened so that you can function with less discomfort. They also cause the brain to release the hormone dopamine, making you feel happy or relaxed.
However, opioids can also slow your heart rate and breathing.
Opioids are used to treat severe pain associated with cancer or acute pain, for example following surgery.
They’ve also been used for many years to help people with severe, persistent non-cancer pain, like the pain associated with musculoskeletal conditions.
However, extensive research now shows that opioids don’t provide ‘clinically important improvement in pain or function compared with other treatments’ for most people with persistent pain or chronic pain.(2) This research, combined with our knowledge of the serious side effects of opioid medicines, particularly with long-term use, mean that these medicines should be used with caution.
All medicines have side effects, so it’s important to know what they are. Side effects of opioids include sleepiness, constipation and nausea. More serious side effects include shallow breathing, slowed heart rate and loss of consciousness. These serious side effects may be due to too many opioid medicines being taken (an overdose). This can be life-threatening, so you need to ensure that you know when and how to take your medicines to prevent an accidental overdose.
Addiction is also a possible side effect of opioids.
Opioids, when taken long-term, can also make you feel more pain. This is called opioid-induced hyperalgesia. It happens because opioids make the brain and nerves more sensitive to pain.
Your body adapts to opioids when you use them long-term. This is called tolerance. To get the same pain relief, you need to increase the dosage. However, it’s not safe or sustainable to continue to increase the dosage of opioid medicines because of the serious risk of harm associated with their long-term, high-dosage use.
Dependence is when your body requires a specific dose of the medicine to avoid withdrawal symptoms when the dose is reduced or stopped. Symptoms of withdrawal can include: disturbed sleep, hot and cold flushes, sweating, feeling anxious or irritable, cravings for opioids, nausea, vomiting, diarrhoea, lack of appetite and tremors.(3) You’re more likely to experience withdrawal symptoms if you’ve been taking opioids for a long time and/or taking high doses.
Your doctor will slowly reduce your dosage to lessen your risk of withdrawal symptoms. This is called tapering.
Because of the risks associated with their use, opioids aren’t a first-line treatment for managing pain associated with musculoskeletal conditions. Instead, your doctor may suggest strategies such as exercise, maintaining a healthy weight, cognitive behavioural therapy (CBT), heat and cold packs, distraction, and short-term use of medicines such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
If you are prescribed opioids, it’s important that you:
While using opioid medicines, you should also monitor whether or not they’re working for you. If you’re still experiencing severe pain that’s affecting your quality of life and ability to do daily activities, discuss this with your doctor. Together you can look at alternative treatment options.
Finally – it’s important to understand that opioids reduce our perception of pain. They don’t ‘kill it’, because there’s no such thing as a ‘pain killer’. Medicines and other strategies such as heat and cold, exercise, distraction and CBT can help you reduce pain to levels that enable you to live a healthy and happy life.
If you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services, call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.
Travelling can be an incredible adventure, but it can sometimes cause anxiety and stress if you have a chronic condition.…
Most people don’t realise that gout is the most common form of inflammatory arthritis in the world. According to the…
As siblings living with psoriatic arthritis, Musculoskeletal Health Awareness Month holds significant importance for both my sister, Brooke, and me,…
Did you know more than half of your body is made up of water? And while we can survive for…
Supporting clinicians to consider sexual function within a person-centred approach to musculoskeletal pain care A new paper led by Professor…
"Whooooa, and don’t it feel good!" Gotta love the eighties and music from bands like Katrina and the Waves, right?…