Health

Why are opioids still given for chronic pain?

We all know what it is to feel pain. Acute pain, that is, such as slamming your finger in the door or grazing your knee.

Chronic pain is different. It might be triggered by arthritis, an injury to your back or by an operation you never completely recover from.

According to the British Pain Society, chronic pain affects more than two-fifths of the adult population in the UK, meaning about 28 million adults are living with pain that has lasted for three months or longer.

And each year, according to a recent Public Health England report, about five million are prescribed opioids – painkillers that can be as powerful as Class A drugs.

In fact, the latest data suggests patients are being prescribed more than twice the amount of opioids they were 20 years ago.

There's no doubt opioids have a vital role to play in cancer pain, end-of-life care or to relieve pain after an operation. But that doesn't begin to explain the surge in prescribing we've seen in recent years.

However – if you are taking opioids – you certainly shouldn't stop without talking to your doctor.

Decades-old beliefs

So what are opioids? Originally, they came from the sap of the poppy plant – which has been used for thousands of years both recreationally and to treat pain.

Morphine and heroin are opioids. They act on the opioid receptors in the brain, blocking pain signals from the rest of the body.

In fact, they're probably the greatest tool doctors have for numbing acute pain, such as a broken bone or an infected tooth.

The downside of long-term opioid use is it puts you at increased risk of constipation, memory loss, addiction – and even accidental death by overdose.

One reason for the massive rise in opioid prescribing is of a mistaken belief people in pain are very unlikely to become addicted. This is certainly what I was taught at medical school in the 1980s.

But according to Dr Jane Quinlan, consultant in pain management at Oxford University Hospitals Trust, this widespread belief was based on fallacies that took hold in the 80s.

"Two things happened," she says. "One of them was that evidence came from palliative care, looking at patients at end-of-life and who had pain, to say that giving patients like that high-dose opioids was safe because they didn't get addicted.

"Around the same time, a letter was published in the New England Journal of Medicine claiming that patients who were in hospital and given opioids for a short time rarely got addicted."

This 100-word letter wasn't peer-reviewed research – it was simply an observation.

But its tentative conclusions were inflated by pharmaceutical companies who began aggressively promoting opioid use as a safe and effective way to treat all manner of pain.

'Red-hot poker'

Unfortunately, many patients soon discovered that isn't true.

Karen, who in 2014 slipped a disc in her spine bending over to pick up a book, was one of them.

"It was like having a red-hot poker, put between your vertebrae," she says. "Painful, very painful."

Over the next five years, Karen was put on increasingly powerful opioids – starting with tramadol and ending up with morphine. But they failed to sort out the pain.

What they actually did, according to Karen's husband, Ray, was turn "my beautiful, lovely, active wife into a zombie".

Karen's case is not unusual. GPs were encouraged, by national guidelines, to keep upping the dose until the patient was pain-free.

The trouble is, when it comes to chronic pain, opioids are often not that effective.

In fact, another leading pain expert, Dr Cathy Stannard, estimates fewer than one in 10 people given opioids for long-term pain will benefit from them.

They are also "dangerous and often expensive", according to Dr Stannard, who recently reviewed the evidence on the benefits of long-term opioid use.

"They should be started only with caution and with upper dosing limits and contiRead More – Source