Opioid analgesics for chronic pain

Examples

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Brand Name	Generic Name
Buprenex	buprenorphine

Brand Name	Generic Name
Stadol	butorphanol

Brand Name	Generic Name
Tylenol with codeine	codeine

Brand Name	Generic Name
Duragesic	fentanyl

Brand Name	Generic Name
Vicodin	hydrocodone

Brand Name	Generic Name
Dilaudid	hydromorphone

Brand Name	Generic Name
Dolophine	methadone

Brand Name	Generic Name
Astramorph	morphine

Brand Name	Generic Name
OxyContin	oxycodone

Brand Name	Generic Name
Darvon	propoxyphene

Opioids are available in pills, liquids, or suckers to take by mouth, and in shot, skin patch, and suppository form.

How It Works

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Opioid analgesics suppress your perception of pain and calm your emotional response to pain by reducing the number of pain signals sent by the nervous system and the brain's reaction to those pain signals.

Why It Is Used

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Opioids are used to reduce moderate to severe chronic pain.

How Well It Works

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Opioids are effective in relieving moderate to severe chronic pain. Higher doses may be more effective, but higher doses also can cause more side effects.¹

If one opioid does not reduce your pain, your doctor may prescribe a different opioid to treat your chronic pain.

There is a low risk of addiction if you take opioids routinely as prescribed. Your risk of addiction is slightly greater if you have a history of substance abuse.²

Side Effects

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Opioids may often cause side effects such as:

• Constipation.
• Drowsiness.
• Dizziness.
• Weakness.
• Dry mouth.
• Sedation.
• Confusion.
• Difficulty urinating.

More serious side effects can include allergic reaction, such as swelling of the throat, a drop in blood pressure, seizures, tremors, or hallucinations.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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In some cases, more than one type of opioid medicine may be prescribed to relieve pain without increasing the individual dose. Many combinations of opioids with non-opioids have been effective, such as combining opioids with aspirin or acetaminophen.³

You may become physically dependent on opioids if you take them regularly. Physical dependence is not addiction, but rather a gradual change in your body in response to the opioids. If you stop taking opioids abruptly, you may develop nausea, sweating, chills, diarrhea, and shaking. The physical dependence and withdrawal symptoms are not life-threatening. You can avoid withdrawal symptoms if you gradually stop taking the opioids over a set period of time, as prescribed by your health professional.

Opioid analgesics are potentially addictive, but the risk is small when they are properly prescribed and taken by people who do not have a history of substance abuse. In the past, opioids were used only for short periods for short-term pain or for cancer pain. Many experts now also use opioids for longer periods to treat chronic pain. You can take opioids to reduce pain and increase your functioning without becoming addicted to them.

If you are about to begin a long-term course of opioids, increase the amount of fiber in your diet and drink more water. This will help you avoid constipation. Also talk to your doctor about whether you should take a stool softener or laxative.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Rowbotham MC, et al. (2003). Oral opioid therapy for chronic peripheral and central neuropathic pain. New England Journal of Medicine, 348(13): 1223–1232.

2. Dworkin, RH, et al. (2003). Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Archives of Neurology, 60(11): 1524–1534.

3. Carver A (2005). Pain. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 14. New York: WebMD.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Last Updated	February 22, 2007