Low Back Pain And Opioids Prescriptions
Most Common Questions About Opioids And Back Pain
In this article we are to discuss back pain and how it interacts with the opioids, pain medicines like Oxycontin, Oxycodone, and Hydrocodone.
Are you likely to receive significant relief? Are they really beneficial? Do they improve the outcome of back pain in general? Are they likely to be associated with some kind of complication?
If you take the drug, you likely to continue taking it for long period of time and you likely to become tolerant or dependent on the drug. Is there any difference between dependence and addiction to the drug?
If you take the drug, are you likely to have some complications? Complications that might be relatively mild for maybe you're going to suffer significant constipation. Maybe they're going to lead to depression. If you're a man, whether you may be suffering erectile dysfunction (impotence).
If you take the drugs, are you likely to get back to work more quickly than if you don't take the drugs? Or the drugs really demonstrably better than just those over-the-counter medicines that you can take? The medicines in the family of the Naproxen or the Ibuprofen.
Here in the United States, we have a tendency to believe that prescription medicines are better than non-prescription medicines, whatever they are whatever the purpose. That's not necessarily the case. We also have a tendency to believe the more expensive medicine is going to work better. Again, not necessarily the case.
Problems Associated With Pain And Use Of Narcotic Drugs
If we talk about back pain in general, extremely common most of us at some point in our adult lives are going to suffer from back pain, either neck pain or low back pain. As a matter of fact, that's the significant cause of activity limitation and people not being able to go to work - workplace disability.
And even if you don't work it is a significant problem with disabling back pain. It's going to interfere with your ability to carry on your normal activities. Back pain is a major cause for seeking medical help. Overall back pain has a significant impact on individual's ability to function.
It's going to have a significant impact on the healthcare system in general. How the health care system interacts with people, how we perform surgeries, do we need surgeries? Or too many people being operated on. It is also going to have a significant impact on national economies. We know the significant number of people not going back to work and become disabled. The significant number of people not going to have the same standard of living, not going to be able to enjoy their lives.
Obviously, back pain is a major problem. As a matter of fact, if we look overall at the narcotic pain medicines, more than half of them are prescribed for people who have back pain. If you happen to be in the United States or Canada, it's two times greater than you're going to receive a pain medicine for one of the opioids and narcotic pain medicine then if you happen to live in Europe.
How effective are they? Well, at least if we talk about an acute pain, the effectiveness is inferred from other kinds of problems, where you have acute pain.
Whether they really translate back pain? It is questionable. There are more issues associated with back pain that we have to consider. So, if you take a narcotic pain medicine, are you more or less likely to return to work then if you take nonsteroidal anti-inflammatory medications.
There's some evidence that the treatment for pain may impact on your ability to get back to work.
If we look at chronic low back pain, not acute low back pain but chronic low back pain - are medicines likely to help? It's interesting that we have very little evidence for the medicines being what we call efficacious really working. We have some randomized controlled trials that are supposed to be good news. However, unfortunately, they were highly selected patients, not like the people who are getting the drugs out in society. There was a high dropout rate most of the studies and the studies tend to last for only a couple weeks.
So, yes, maybe they help the pain part, but remember, a part of the disease is your ability to be able to function. As a matter of fact, their ability to improve your function is nebulous. We don't really have great information that's indeed the case. Some studies suggest that if you take the narcotic pain medicines you're going to be less likely to be able to function.
When you take the pain medicines everyone thinks: “Oh, my goodness! I'm going to take pain medicines and not going to have any pain! I'm going to be pain-free!”. But that's not necessarily the case with the opioids or the narcotics. In reality, such drugs seem to improve the pain by maybe about 30% - not 50%, not 50%! You still have the pain, it's still in the background.
But it's not going to necessarily get rid of it. As far as the long-term safety, we see so many people in the course of routine practice. I see people every day who have been taking the medicines for 1, 3 or even 5 years. They take them because the doctor gave them to because he or she had some back pain and it worked.
A question is - do we know anything about the long-term safety, long-term efficacy?
Well, it is unstudied and unknown. People who take the medicines for a long enough period of time are going to have some problems with them. You're going to become tolerant to medicine.
Instead of taking 1 pill every 6 or 8 hours, you're going to be taking 2 or 3 pills. Some people take considerably lot more.
Moreover, sometimes the pills interact with the body in a way that causes what we know as hyperalgesia - the pain pills can actually cause more pain!
As you can see, we have a series of issues with these medicines. We have the problem of addiction. A lot of people who take the drugs for a period of weeks to months are going to become addicted to the medicines. They not going to be able to get off the medicines without having a variety of other symptoms.
They start to taper, they develop some symptoms they assume that the primary disease that they were taking them for is returning. And they can't get off the medicines. But it wasn't that the pain is coming back, it's that the complications of getting off the medicine are making matters worse.
And then we have another issue. We worry so much about when a small number of people are injured by the airbags in their cars. We worry about the tires, we worry about the gym sets, because they cause a small number of people to die. And that's something that we should look at.
The next problem is, these narcotic pain medicines cause somewhere around 16,000 or 17,000 people to die every year. That's a major cause of death. It puts it in the major top 10 group in the United States. And we seem to be spending little effort, a little discussion about that.
In short-term when you take these medicines, you are not going to have complications. Of course, you are going to have complications like constipation. How many times when you discuss pain control with people are you going to find people complaining that they have constipation?
Other side effects include belly pain, nausea, sedation, the difficulty the ability to stand and walk. A significant number of people, especially the elderly, are taking these medicines for back problems. As you become older you have more of a likelihood of falling and fracturing a bone.
If you take the drugs for a long period of time, it is an issue with depression. It seems that depression has a tendency to cause pain. Pain then generates people taking the narcotic pain medicines. However, the narcotic pain medicines tend to cause depression to get worse. And if you didn't have depression when you started taking the drugs, often times you're going to develop depression anyway. So. we have a vicious cycle.
There is also an issue of sexual dysfunction for both men and women. You hurt your back at work and you're a guy. You start taking these drugs and the next thing you know is a delayed reaction. You may end up suffering from erectile dysfunction.
Things To Improve Regarding Opioids Prescriptions
What do we need? We need more selective prescriptions, we have to pick the people appropriately who really need these medicines. And we have to use the medicines for an appropriate period of time and that's not for years and five years and longer.
You have to be able to monitor people, monitor the prescriptions. make sure the people who get the medicines are really the ones who are taking the medicines. And we have to, the most importantly, consider other kinds of medicines interactions.
Remember the studies that were done to show the medicine supposedly worth? Well, they were done in people who were not taking sedatives, who are not taking the narcotics with the sleeping pills and anti-anxiety medicines. They weren't drinking a lot of alcohol.
We have to consider all of those things and then we have to make the medicines formulate them in a manner that would preclude them or avoid them being able to be smoked and snorted and injected.