What Should I Know About Opioids and Living With Chronic Pain? | Addiction Medicine | JAMA Internal Medicine | JAMA Network
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May 26, 2020

What Should I Know About Opioids and Living With Chronic Pain?

JAMA Intern Med. 2020;180(7):1036. doi:10.1001/jamainternmed.2020.1679

At one time, chronic pain (lasting longer than 3 months) was routinely treated with opioid pain medications (oxycodone, morphine, codeine, etc). But we now know that opioids are less effective and more risky than we thought, so many people are choosing other ways to treat chronic pain.

What Are the Risks of Opioids?

Even when taken as directed, opioids can cause side effects. These include tolerance (requiring more medication to have the same effect), dependence (developing unpleasant withdrawal symptoms if you stop taking opioids), increased sensitivity to pain, depression and fatigue, constipation, low sex hormone levels, itching, sweating, and overdose (slowed breathing, sedation, and possibly death).

Should I Start Taking an Opioid for Chronic Pain?

Taking an opioid medication should not be the first choice for chronic pain that is not caused by cancer. Evidence shows that less risky medications such as ibuprofen and acetaminophen can be equally effective. If you and your doctor decide you should start taking an opioid medication, it should be a part of a comprehensive pain treatment plan. Opioids should never be the only chronic pain treatment. Starting an opioid medication should be done as a limited trial with a set end date before reassessment of the risks and benefits of continuing treatment. Frequent consultations are necessary while taking opioid medications to assess pain control, physical function, quality of life, and safety.

If I Take Opioids for Chronic Pain, Should I Decrease or Stop?

There are many indicators that you should consider gradually decreasing or stopping your opioid medication, but you should not stop taking opioids suddenly unless you have a life-threatening side effect. Make a plan with your doctor to gradually decrease your use. Consider stopping opioids if you continue to have poor pain control and difficulty functioning in your life while taking opioids; studies show that if opioids are decreased slowly, pain and function can actually improve. Stop taking opioids if you experience significant side effects, if you have medical conditions or take other medications that put you at increased risk for side effects from opioids, or if you take high doses of opioids.

If you develop cravings for opioids or begin to lose control of your opioid use (eg, taking more pills than prescribed, taking other people’s opioids), it could be a sign of opioid use disorder (formerly called opioid addiction). If you notice any of these behaviors, talk with your doctor right away. There are effective treatments for these symptoms that can also help with pain control. If you start to feel depressed or hopeless in the setting of decreasing or stopping your opioids, contact your doctor immediately.

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Section Editor: Michael Incze, MD, MSEd.
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Article Information

Author Affiliations: Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco (Leyde); Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco (Azari).

Published Online: May 26, 2020. doi:10.1001/jamainternmed.2020.1679

Conflict of Interest Disclosures: None reported.

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    1 Comment for this article
    Wish would have added
    Steven King, M.D. | Pain Medicine
    Many lay people and, unfortunately, not a few medical professionals still believe the choice is between opioids, NSAIDs, and acetaminophen for pain. I know that the authors couldn't be expected to mention all other treatments but I believe it would have been worth noting other non-opioids such as the SNRIs and gabapentoids and also non-pharmacologic treatments that have been found to be as effective and, for many types of pain, more effective than opioids. I've often heard patients tell me they have to take opioids because they can't take NSAIDs and there have no alternative.