Opioids for chronic pain? Think again, says SIU internist
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SIU internist Dr. Rexanne Caga-anan regularly sees new patients asking for refills of their narcotics. “I see it at a very alarming rate,” says Dr. Caga-anan. “Depending on how the patient is, it can either be a very long or a very short interview, but either way, it’s a very difficult conversation to have.”
Patients can become dependent on opioids in just 7 days. That’s why Dr. Caga-anan highly recommends that physicians limit opioid prescriptions to 3 days for acute pain. Patients on prescription opioids must also sign a pain management contract. Under the contract, patients must agree to take the prescription as prescribed and not to share their prescription or take any illicit drugs. The clinic regularly checks patients’ urine to ensure they’re compliant with the pain contract.
“For so long, patients have been under the impression that when they’re in pain, they need a narcotic,” explains Dr. Caga-anan, who lists just 3 instances in which prescription opioids are appropriate:
- Active cancer treatment
- Palliative or end of life care
- Acute, short-term pain following an injury or surgery
Dr. Caga-anan and the CDC agree: Opioid therapy should play no role in chronic pain management.
According to the CDC, evidence to support opioid therapy for chronic pain remains “limited, with insufficient evidence to determine long-term benefits versus no opioid therapy.” Evidence does suggest serious harms that appear to be dose-dependent: constipation, arrhythmia, drowsiness, nausea and vomiting.
For patients who have been prescribed opioids to treat chronic pain for years, Dr. Caga-anan warns, patients may not know they have a problem.
“Usually a lot of these patients have been on prescription opioids for decades,” Dr. Caga-anan shares. “It usually starts with a very simple complaint, like a sprained ankle, a trip to the ER where they were given narcotics, and for some reason, nobody took the time to wean them off. It’s very easy to become dependent on these medications.”
Opioids should never be the first line of treatment, says Dr. Caga-anan, who recommends first treating pain with over-the-counter pain relievers like acetaminophen or anti-inflammatory agents such as ibuprofen. “It is very important that we seek to identify the etiology of the pain, so that we can address it directly,” Dr. Caga-anan explains. To treat neuropathic pain, for example, physicians can prescribe pregabalin or gabapentin. Antidepressants can also play a role in pain management.
“Patients may benefit from physical therapy, conservative management such as hot/cold compresses, topical agents, or even behavioral or cognitive therapy to help manage their pain,” explains Dr. Caga-anan, who adds that in some cases, surgery may be appropriate. “We can involve other specialists to help us with pain management, if indicated.”
Suspect you or a loved one may have a problem? Speak with your SIU physician about counseling and treatment options. Make an appointment by calling 217-545-8000.