What are opioids?

Opioids provide pain relief by acting on areas in the spinal cord and brain to block the transmission of pain signals.

Opioids are considered to be some of the strongest painkillers available and are used to treat pain after surgery, serious injury and cancer. Opioid drugs can help manage some but not all types of chronic pain.

What should be the aim of treatment when using opioids?

What you expect from your treatment should be discussed with your doctor, prior to starting opioids. Though it is easier to treat pain after surgery or a significant injury with painkiller medicines, it is rarely possible to relieve long-term pain completely by using painkillers.

Specific goals of opioid treatment will differ according to the patient’s circumstances; however these should be agreed with your doctor prior to starting an opioid. This will help you track how you are getting on with your medication.

The goals of treatment may be as simple as ‘having increased mobility’, or as significant as ‘returning to work’. It is important that any goals of treatment are realistic, attainable, and are regularly reviewed by yourself and the GP.

What else can I do to help reduce the pain?

Medicines work best if you combine them with other ways of managing symptoms such as regular activity and exercise, and doing things that are satisfying or enjoyable, such as work or study, and social activities. Setting goals to help improve your life is an important way to see if these drugs are helping.

What are the risks of taking opioids long term?

Long-term pain arises through many different mechanisms, and most drugs only work for one of these. Some pains do not seem to respond to any painkilling medicines. You can get used to painkillers, including opioids, so that you need more and more to have the same effect. (This is called building up tolerance.)

However, we know that high doses of opioid medicines taken for long periods are unlikely to give better pain relief and are associated with a number of problematic adverse effects.

When should I stop using opioids?

Upon review with your doctor, if there has not been a reduction in pain intensity or a general improvement associated with the pain symptoms, the opioid has not been effective and should be discontinued.

Opioid based medication – potential side effects

Side Effect	Description
Respiratory depression (from overdose)	Overdose the slowing of breathing resulting in your speech being slurred, and you may not be able to walk properly. Should you experience any of these symptoms, you need to seek urgent medical care.
Constipation	Constipation is a common side effect of opiates. Ensure you eat a well- balanced diet, drink plenty of water and if constipation continues, speak with your doctor.
Cognitive impairment	You may not think as clearly when using opioid medication and this is likely to worsen with higher doses. Taking the medication may make you feel ‘spaced out’ or ‘relaxed’ rather than reducing your pain. This might indicate that you are using the medication for the wrong reasons e.g. to relax rather than reduce pain
Depression and anxiety	There is an increased risk of depression and anxiety when you take opioids for long periods of time. This can make managing your pain even harder.
Increased pain levels	Higher doses of opioids can make you become more sensitive to pain. This is due to changes in your nervous system that happen with long-term pain and long-term opioid use. Increasing the dose further will not make your pain improve and increases your risk of becoming dependent on the medicine and other harm from them.
Hormonal effects	Using opioid medication for more than six months can influence sex hormones, which can cause impotence in men and loss of libido in both men and women.
Tolerance, Dependence and Addiction	Opioids can become less effective with time (this is called tolerance) meaning your body has got used to the pain-relieving effect of the medicine. You can also become dependent on opioid medicines (dependence). This means that if you stop taking the drug suddenly, or lower the dose too quickly, you can get symptoms of withdrawal. In rare cases, patients can become addicted to opioids. People who are addicted to opioids can feel out of control about how much medicine they take or how often they take it. Some people are prone to opioid addition, specifically if they have a history of depression or mental health issues
Increased risk of falls and fractures	Long-term or high dose opioids increased your risk of falling and of developing osteoporosis, both of which can lead to bone fractures.
Dry mouth	Lack of saliva can increase your risk of dental caries and tooth loss