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What are opioids and how are they used to treat chronic pain?

Hi, I’m Gordon Irving, Medical Director
of the Swedish Pain and Headache Center. Let’s talk today about pain and narcotics – another
term for narcotics are the “opioids.” You know, North America uses 80 percent of
the world’s medical opiods, or narcotics. Does this mean we’re sicker? Does it mean
that we treat pain better than all the other countries? Or has the prescribing of these
medications just gotten away from logic with problems both for the patient and society?
There are good things to say about prescribing opioids for chronic pain but there are also
concerns. In this talk, we’re going to look at the role of the opioids in chronic pain
under three main headings: the good, the bad and the law. The good: We know that opioids do not damage
the kidneys, heart, liver or gut unlike the anti-inflammatories, like Aleve and Advil.
Many medical societies, such as the American Pain Society and the American Geriatrics Society
have all recommended opioids be part of the treatment for chronic pain. In the late 80s
and 90s, many health-care practitioners felt pressured by newspaper reports of inadequate
chronic pain treatment and by pharma companies touting the efficiency and safety of their
own opioids. The patients themselves, because of the web,
became more insistent on demanding better pain relief. So opioids were prescribed in
ever-increasing numbers with decreased pain and increased physical function experienced
by many. Various opioids were developed – some older ones, such as morphine and codine, they
initially came from the poppy, and then newer synthetic opioids like oxycodone, hydrocodone
and fentanyl. We learned that there are numerous opioid
receptors in the body, and even more subtypes of these receptors. And we’ve also learned
that people have unique populations of these receptors, so if one type of opioid didn’t
help one person’s pain, another type might. Opioids were made with different duration
of action – they could be short-acting for breakthrough pain, they could be long-acting,
lasting all day. They could be taken under the tongue, applied in the form of a patch.
So the health-care practitioner had a large arsenal of different preparations. That was
the good. What about the bad? Although we knew that opioids could be addictive
and cause side effects such as nausea, itching and constipation, apart from the constipation,
side effects tend to be short-lived. Unfortunately, as the number of people who are being placed
on high doses of long-term opioids has increased, we’ve begun to recognize their effects on
other parts of the body. We now know the effect of various hormone
productions primarily on the brain. So in both males and females, testosterone production
is lowered. Apart from the loss of sexual libido, it can adversely affect mood, bone
density, muscle mass. It may even worsen hardening of the arteries. The production of the stress
hormone cortisol is also lowered, making response to stress less effective. Opioids may also
lower the body’s immunity, increase sleep disturbances, and can cause an increased sensitivity
to pain. This increased sensitivity, called opioid-induced hyperalgesia, means that you
feel more pain because of the opioids so that if you have an injury or surgery, you feel
pain much more acutely and for longer than someone who’s not taking opioids. Worse,
increasing the opioids, taking extra to try and stop the extra pain, does not help very
much. Finally, we have statistics showing that as
the amount of opioids prescribed has increased, so has diversion and deaths. In some areas,
highschoolers have said it’s easier to get a hold of opioids, such as oxycodone, than
alcohol. This has led to the said fact that there are more deaths involving opioids in
Washington State than death caused by motor vehicle accidents. That brings me to the third thing: the law.
In Washington State on January 2, 2012, an opioid prescribing law, House bill 2876, came
into be. It was an attempt by the legislature to try and rationalize the prescribing of
opioids. It specifically states, the law does not stop health-care practitioners prescribing
opioids. But it does mandate that they keep reasonable records of why they are prescribing
it, what they hope to achieve, and what are the results of them prescribing these very
strong pain killers. And also, has the patient’s function improved. Are other problems such
as depression, high anxiety being adequately treated? You can imagine there was a huge public outcry
about the government getting involved with medical care, even though the law itself is
nearly encapsulating recommendations made by most specialist societies involved with
pain around the world. The fact is, even now the law has had one effect: opioid-related
deaths have decreased over 50 percent in certain populations. So even at this early stage,
it appears that lives have been saved by this law. So, we’ve looked at the good, the bad and
the law. Are they still recommending opioids for chronic pain? I personally feel they are
extremely useful in improving the quality of life in some patients. But if you are taking
opioids for chronic pain, or if you know someone close to you who is, you should ask a simple
question: what is it that you, or the other person, is able to do physically when you
were put on the opioids that was not possible before starting them? In many cases, when
patients take a hard look at their quality of life and their physical functioning since
being on opioids, all other drugs may take the edge off the pain, they have not been
very effective over the long term.

29 thoughts on “What are opioids and how are they used to treat chronic pain?

  1. I take prescription Tylex opioids for chronic severe pain. I have to have them or I couldn't continue to work.
    I don't know if I could continue without them. I am glad such drugs are available on prescription.

  2. doctors like you make it hard for marginalized peoples like myself to get narcotics for pain. I am in a population demographic that are centred out for drug and alcohol hysteria and then when I even walk through the door at my gp's and get told flat out we don't do narcotics here Mr. Smith. I have at times had to go and sneak around to sequester a supply for my pain. I believe they call it "iatrogenic pseudo- drug- seeking behaviour. No?

  3. Did you ever try cannabis sativa? It is absolutely non-toxic and has been used for thousands of years in all nations and cultures.

  4. No, never tried it. It's not really legal in this country and I believe the present (Tory) government are toughening up on cannabis use. I am sure cannabis has been used throughout history safely by many people but the stuff coming onto the street in recent years is a lot stronger (skunk) and may be connected with mental illness in some people.
    Thanks for the input anyway!

  5. Hello 
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  6. Nyloxin provides all-natural anti-inflammatory analgesic pain relief that is non-toxic, non-narcotic, non-addictive, non-steroidal and contains no aspirin or acetaminophen. Safe to use without a prescription, it treats conditions that cause chronic pain, including lower back pain, rheumatoid arthritis and other joint pain, headaches and migraines, neck pain, neuralgia, repetitive stress pain and more.
    Deny the Pain! http://www.MyNyloxin.com/nabrubus

  7. My mom had a major stroke, and now has painful bedsores….she is in hospice, and now they want to use morphine on her, 25 mg  dose ?   Im afraid they might kill her with the drug…..any advice?

  8. I have been on Oxycodone for many years due to chronic pain from Fibro, injuries, surgeries and other health problems. I believe this doc put it in a nutshell: do the drugs increase or decrease your quality of life? Without them I am stuck in bed all day wishing I would just not wake up. With them I can get up, participate in life and ride my Yamaha Super Charged Waverunner on the lake for up to 4 hours at a time. Yes, I'm in pain from all the physical activity but at least I can be a participant in life instead of a miserable bystander.

  9. I've been taking oxycodone as needed for about 6.5 years now. It's still my go to drug when nothing else works. Without it I would have days where I can barely walk. For what it's worth. I can still stop and start it without any real symptoms of withdraw.

  10. This prick has never had chronic pain. He must work for aleve and advil. Whenever a doctor uses the word ( may ) do this or that it is a red flag that they do not know. Opioids are a great medicine if used correctly. Don't accuse and sentence the drug get the abusers.

  11. people of the older age that are in chronic pain everyday of their life. pain meds is why we are still alive and haveing some what of s life. until you live in this world you don't know. we thsnk god for the meds that can help some what it doesn't take all the pain away. it helps with somewhat a life. we all make choices the young, yes it is a big problem. but us old people who can't get out of the bed without pain meds leave us alone. either way we are on our way out let us be.

  12. wouldn’t it be sensible for the media to distinguish street drugs such as heroin from pain pills? We’re talking about radically different groups of users.

    Third, virtually all experts agree that fentanyl and related drugs are driving the overdose epidemic. These are many times stronger than heroin and far cheaper, so drug dealers often use them to lace or replace heroin. Yet, because fentanyl is a manufactured pharmaceutical prescribed for severe pain, the media often describe it as a prescription painkiller –

  13. TRAMADOL. My case: TKA or TKR Total Knee Replacement. Revision operation 2018. Now in recovery with pain. Here in Thailand, Oxycodone, OxyContin “Hillbilly Heroin” only for cancer patients. TRAMADOL (weak opioid) is good enough. Also for my Mother in law and her arthritis. My recommendation not more than 50 mg per day with strong coffee no sugar! Bangkok Johnnie CarSanook Media THAILAND

  14. Dr. Irving is an incredibly talented doctor, and an intelligent researcher. As my pain doctor, he helped nurture and strength the hope I had for my future and my ability to manage my pain, which in turn, I believe saved my life.

    The booklet he created on his treatment model for managing pain, called “STOMP”, exemplifies the level of expertise and genuine concern he had/s for pain patients and their quality of life. I am now a leader of a chronic pain support group, and many members who attend the support group meetings have asked for a copy of his STOMP booklet. For anyone with a chronic illness and or pain condition, I highly recommend downloading the “STOMP” pdf booklet from Swedish hospital.

  15. If I don't take the oramorph I'm stuck in my bedroom in a lot of terrible pain!! If I take oramorph I feel so much better and play with my children and do other things. So either sit in bedroom not taking oramorph and being grumpy because I'm in pain or take it and have a life!!

  16. Great video❤👍 is oramorph ok to take for chronic pain? Because it actually works for me. I'm just scared of having to ever come off oramorph because I know from experience it's not nice going through oramorph withdrawal.

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