Opioids (narcotic analgesics or painkillers) are used to treat both acute and chronic forms of pain. These drugs work by acting as an agonist on different types of opioid receptors in the human body, which results in a beneficial therapeutic effect. However, for some people, these drugs have adverse effects.
Adverse Events and Reactions
Doctors should fully weight the benefits of opioid therapy with the risks, as well as take in to consideration the many adverse events. Patients with certain medical conditions are more at risk for adverse reactions than those without co-morbidities. Common adverse events of opioids include:
- Respiratory depression
- Urinary retention
- Pruritus (itching)
Use with Caution
In certain circumstances, opioids should be used with caution. This includes impaired ventilation, liver failure, renal insufficiency, bronchial asthma, and increased intracranial pressure.
One of the main reasons narcotic analgesics do not work for chronic pain is physical dependence. With long-term use of opioids, physical dependence develops. While physical dependence is not the same as addiction, it is a state of physiological adaption characterized by withdrawal syndrome when there is an abrupt discontinuation of the narcotic agent. Withdrawals are related to decreasing serum concentrations of the medication, and/or the administration of an inhibitor or antagonist of the medication, such as Narcan.
Addiction to narcotic analgesics is a common thing. Addiction is a chronic neurobiological disease that has many psychosocial, genetic, and environmental factors that influence its occurrence. One of the main characteristics of addiction is the continued use of a drug even after impaired control and detrimental health effects occur.
In the last couple of decades, abuse of medications, like Roxicet and OxyContin, has remained at epidemic levels. There is a societal concern regarding abuse of narcotic analgesics. This has prompted the presidential administration to seek legislation requiring physicians to have certain training before prescribing these types of drugs.
The Root of the Problem
Narcotics are obviously systemic, and don’t just provide relief at the painful area. They reach the liver, the adrenal gland, all over the body. As such, they may lead to significant hormonal abnormalities and complications. This is because the opiates don’t go right to the root of the problem.
Interventional Pain Management
For many people with chronic pain, interventional pain management techniques will successfully relieve pain without the use of powerful narcotic analgesics. The most common causes of chronic pain are related to the musculoskeletal system, such as the neck, back, or joints. Interventional pain management professionals use many advanced treatment options to control chronic pain. The treatment depends on the diagnosis. Available options include:
- Trigger point injections – These injections are given into trigger points, which are areas of contracted tissue along the neck, back, and other body regions. The doctor injects the areas with an anesthetic, corticosteroid agent, and/or Botox.
- Selective nerve root blocks – Depending on the site of pain, the doctor can inject an anesthetic, neurolytic agent, and/or corticosteroid medication onto the affected nerve bundle.
- Epidural steroid injections – This involves injecting a corticosteroid (with or without an anesthetic agent) into the epidural space, which surrounds the spinal cord.
- Spinal cord stimulator implant – The spinal cord stimulator is surgically implanted in the body, and wires run to surgically placed electrodes along the spinal cord. Pleasant electrical current sensations interfere with pain signals.
- Intrathecal pain pump implant – This involves surgical implantation of a small pump that delivers medication directly to the spinal cord.
- Joint injections – The doctor can inject the joint with a corticosteroid or hyaluronic acid solution.
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