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Opioid (narcotic) analgesics are a useful tool for some patients when treating chronic pain. Usually, all other treatment options have been explored without success. Exercise and physical activity, nonopioid analgesics, and anti-inflammatory drugs are the front-line approaches to this problem.
In some cases, steroid injections may be helpful. In all cases, patients should be assessed for fear-avoidance behaviors (FABs) and treated accordingly. FABs have been identified as a major psychosocial factor preventing recovery after a back injury.
The patient is afraid of a reinjury or afraid of doing something that will cause painful symptoms. He or she starts to avoid certain movements or activities out of fear. Some experts say that motion is lotion. Eventually, pain is made worse by this movement avoidance strategy.
When all efforts at corrective treatment have been exhausted, then opioids may be considered. They do have a place in pain management for some patients. These drugs can give eight to 24 hours of pain reduction or pain relief. Their effectiveness depends somewhat on the patient's biologic ability to absorb and metabolize (use) the drug.
In each case, the drug must be titrated carefully for the patient. This means the type, amount (dose), and frequency is determined by each patient's response. With proper management, toxicity, dependence, and addiction can be avoided. Sometimes the amount of opioid needed to get the same amount of pain relief increases over time. This may be because the patient develops a tolerance to the drug. Tolerance is not the same as addiction.
When the opioid is working, the patient can start to do more. With increased function, there may be increased pain at the same time. It may be necessary to increase the dose until the pain is under control again. With careful titration, there is a balance between pain, activity level, and side effects.
Together, the patient and the physician monitor the beneficial effects of the medication. Any side effects are reported and treated as needed. Some opioids are meant to be used short-term. Others are known for their long-term effectiveness. Used properly, this class of drug is both safe and effective.
With careful management, they can be used to break the pain-spasm cycle and help patients recover drug-free. Or for patients with chronic pain, they can be used indefinitely to control symptoms, improve function, decrease disability, and increase quality of life for the patient.
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