Taking Opioids for Pain? Speak up. Ask the Hard Questions.

CHICAGO – Opioids often are the go-to pain killer for everything from back aches and injuries to post-surgical pain, as evidenced by the more than 300 million prescriptions written each year. While they can be effective for moderate to severe short-term pain, opioids are not without risk. Because they have significant side effects, including an increased risk of addiction and overdose, the American Society of Anesthesiologists suggests those who take opioids ask some tough questions – including if it is time to consider other options.

Kathleen Callahan understands the dilemma. She suffers from a chronic condition that causes painful cysts that required multiple surgeries resulting in post-surgical and chronic pain for which she took opioids for years. Despite being on a high dose of opioids, Kathleen still had chronic pain. So she turned to Anita Gupta, D.O., Pharm.D., a physician anesthesiologist who specializes in pain medicine, to find an alternative.

“Opioids are a valuable tool for recovery and acute pain but when I was on them long-term, I couldn’t function and I wasn’t enjoying life. I couldn’t be involved in my children’s lives and my work was suffering,” said Kathleen, a mother of two who works in finance. “Dr. Gupta said she could help me manage my pain so my life was livable. With her help, I weaned off all the medication except for the occasional ibuprofen for bad days. Now I can exercise again. I can go to the gym. I can go out with my friends and enjoy myself. I go to my kids’ baseball games, school plays and other activities.”

“Kathleen and I had some difficult discussions. I didn’t think the medications were right for her anymore and I was truthful with her,” said Dr. Gupta. “She asked some hard questions and having these conversations really developed trust between us so I could help her move forward and cope with her pain. Since she’s been opioid-free she’s vibrant, energetic and successful in her career. She has her life back.”

If you are taking opioids or your physician has prescribed them, the American Society of Anesthesiologists suggests asking yourself (and your physician) some tough questions:

Why was I prescribed opioids?

• Some doctors assume patients will demand what many consider the strongest and most effective pain relief and therefore prescribe opioids automatically. But there are many medication and non-medication options, so ask your doctor if other pain relief methods might be effective.
• If you and your doctor decide opioids are the best option, ask how long you should take them. In most cases, opioids are most beneficial for short-term moderate to severe pain – such as a few days after surgery or an injury. If you continue to have pain, ask your physician about alternatives.

Are opioids affecting my quality of life? Opioids have many side effects, ranging from severe constipation, mental fogginess and nausea to depression. Kathleen said she was “exhausted, cranky, depressed, constipated and gaining weight.” The opioids affected her relationship with her kids because she wasn’t involved in their lives. That’s when she realized opioids were worse than the pain itself, motivating her to seek other options.

What are my concerns about taking opioids – or stopping them? With the media attention surrounding opioid risks, many people feel conflicted about taking them. They may:

• worry they are being judged by others;
• be concerned about becoming addicted and/or potentially overdosing; and
• fear they won’t be able to control their pain if they stop taking opioids.

It’s important to talk to your physician if you have any of these concerns or others. For example, ask about obtaining naloxone, a drug that can reverse an overdose if injected quickly enough. If you take opioids when you don’t have pain or use more than directed, you may develop a dependence or addiction.

Is it time to consider other methods of pain management? Opioids are most effective in the short term. While some people with chronic pain find relief with opioids, they should be part of a “multimodal” plan, which features other methods of pain management. Discuss alternative therapies with your doctor, including:

• Injections or nerve blocks – Injection with local anesthetics can short circuit muscle and nerve pain.
• Electrical stimulation and spinal cord stimulation – Electrical impulses sent by devices that are implanted or worn on the body can block pain.
• Physical therapy – Strengthening muscles can improve function and decrease pain. Physical therapy may include other pain-easing methods such as whirlpools, ultrasound and massage.
• Acupuncture – Very thin needles placed in various parts of the body can interrupt pain signals.
• Biofeedback, meditation, deep breathing and relaxation – These methods can ease pain by controlling involuntary functions such as heart rate, as well as learning to ease muscle tension.
• Surgical procedures – In some cases, surgery can correct painful abnormalities or sever the nerves causing the pain.

What type of physician can best help manage my pain? If you have severe or ongoing pain, be sure to see a physician who specializes in pain management, such as a physician anesthesiologist. These specialists have received four years of medical school and additional training in a specialty, such as anesthesiology or physical medicine and rehabilitation, followed by an additional year of training to become an expert in treating pain. They have the expertise to best help you manage your pain.

“These are the difficult questions that no one wants to discuss, but physicians and patients need to talk about them so the patient can get better,” said Dr. Gupta. “If they’re prescribed opioids, patients need  to ask how long they’re going to be on them as well as additional options for treating pain. With all the tools we have there is a lot more patients can do for their pain with their physicians’ help.”

“My entire outlook on pain management has changed,” says Kathleen. “If I didn’t have a physician anesthesiologist on my medical team I believe right now I would be very overweight, inactive, not part of my children’s lives and clinically depressed. When you have a physician like Dr. Gupta who you trust and who shows you there’s another way, it’s just amazing. It’s night and day. I’m even starting to run in marathons.”

For more information download ASA’s Asking the Hard Questions About Opioids. To learn more about the critical role physician anesthesiologists play before, during and after surgery, visit www.asahq.org/WhenSecondsCount.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Like ASA on Facebook, follow @ASALifeline on Twitter.

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