Living & wellness

25 Feb 2021 admin

MANAGING PATIENTS WITH OPIATE USE DISORDERS AND CHRONIC PAIN

Pain is an uncomfortable situation that usually accompanies an illness or injury. Pain is your body’s way of telling you something isn’t right in your system and needs immediate attention. Based on its duration, pain can be grouped into acute and chronic pain. Acute pain is short-lived and can range from a few seconds to three months. It usually accompanies a minor injury or illness and subsides as you heal. On the other hand, chronic pain lasts for a much longer period, usually over three months. This form of pain can last over a long period of months or even years. Although it might not be constant, intermittent pain that lasts over a long period of time is termed chronic. Chronic pain is usually due to health conditions or permanent injuries to your body. In managing chronic pain, physicians recommend different treatment plans, including medications to relieve the pain and help patients live productive lives. One of the commonly prescribed medications are opioids. Opioids are a class of drugs that interact with opioid receptors in the brain to produce physiological effects, the most prominent of which is pain relief. As pain relievers, prescription opioids have been effective in managing moderate to severe pain. However, the side effects of opioids may include feeling relaxed, “good,” or “high.” These pleasurable effects increase users’ risk of developing opioid use disorders. A recent study showed that 9.6% of Canadians who used opioid medications reported some type of misuse. Opioid use disorder is one of the most commonly reported substance use disorders. Globally, an estimated 16 million people are affected by opioid use disorders. Opioids are also responsible for a growing number of deaths due to substance overdose. In Canada alone, over 3,800 people reportedly died from opioids overdose in 2019. Opioids are naturally found in the opium poppy plant, but many synthetic forms have also been produced. Many of these synthetic forms are prescribed for pain management but are also often used illicitly and are responsible for most opioid-related deaths. Fentanyl and fentanyl analogs are one of the most commonly abused opioids. Heroin is another illegal opioid that is highly misused.

manage chronic pain and opioids use disorder


Pain Management In People With Opioid Use Disorders

Pain management in people with opioid use disorders is not linear and is often a combination of multidisciplinary options. Chronic pain is more challenging due to the long-term nature of the pain. One of the biggest setbacks to managing chronic pain is clinicians misjudging that a pain complaint is evidence of drug-seeking behavior of people with opioid use disorder. This may affect the urgency with which treatment is administered and the degree to which pain is managed. To address this issue, clinicians should make it a duty to take a careful clinical assessment of the patient. With proper assessment, personalized treatment plans involving interdisciplinary professionals. treatment can be recommended to effectively manage chronic pain in patients with opiate use disorders.

Opioids as a Medication Option

Even though opioids are effective pain relievers, people with opioid use disorders have developed a tolerance to them over time. They would not experience the same pain-relieving effect as other people with the same doses. People exposed to high doses of opioids have also been recorded to have a higher sensitivity to pain than people who haven’t. As a result, increasing the dose of opioids to produce desired analgesic effects may be counterproductive. To manage this, some clinicians may recommend giving low dose opioids to help manage increased pain sensitivity in patients. In chronic pain, long-acting opioid medication like Zomorph, which slowly releases oral morphine, and Oxycontin, which slowly releases oxycodone, should be considered treatment options. There is also the fear of a patient relapsing to opiate abuse after being treated with an opioid similar to what they were dependent on. However, studies on the risk of a relapse associated with managing pain with opioids have been inconclusive. On the other hand, there is a possible risk of a relapse if the pain is not managed well. Patients may seek out unprescribed opioids on their own to “dull” the pain, which can then lead to habitual misuse.

Maintenance Opioid Agonists and Non-opioid Analgesics as a Medication Option

Some clinicians may recommend using opioid agonists, such as methadone, to manage chronic pain in people with opioid use disorders. These medications do not give analgesic effects as potent as opioids, but they can aid in pain management. The two commonly prescribed maintenance opioid agonists are Methadone and Buprenorphine. These medications are given as daily doses; however, their pain-relieving effects only last an average of 8 hours. As a result, they may be required as a thrice-daily dose. To make up for this, a clinician may recommend non-opioid analgesics such as paracetamol and NSAIDs to manage the pain. Naltrexone is usually recommended for patients who have been detoxified from opioids. It blocks the “good” feeling associated with opioids and so can’t be used with opioids. People using this medication may be asked to combine it with non-opioid medication and non-pharmacologic treatment like cognitive behavioral therapy.

Conclusion

with any form or combination of treatment for chronic pain management, the medical team should set up structures and systems to monitor the patient’s recovery process. Shorter periods between doses of medication should be recommended. The patient should also be reviewed as often as necessary to ensure proper recovery. With opioid medication, patients should be adequately monitored for signs of relapse, and treatment should be changed. Are you struggling with substance use disorders? You can overcome it and get back control of your life. Book a virtual consultation with a licensed physician at www.maplerecoverycentres.ca