A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Alleviating pain has been a primary focus of my career as a physician anesthesiologist. Just as there are physicians who specialize in treating conditions such as cancer, heart disease or allergies, there are specialists in treating pain. These physicians complete four years of medical school and further training in a specialty, such as anesthesiology, physical medicine, and rehabilitation, psychiatry or neurology, followed by an additional year of training to become an expert in chronic pain.

Every day on news outlets throughout the country we see stories about the risks and dangers of opioids. More than 300 million opioid prescriptions are written each year. Many people feel conflicted about taking them and pain medicine specialists throughout the country are working to help patients in pain use a wider variety of medications and therapies to effectively ease pain. For many patients, who have long-term or chronic pain, I suggest they ask their pain medicine specialist some tough questions about the risks and side effects of taking opioids.

One of my patients, Kathleen Callahan understands the dilemma of taking opioids long term. She suffers from a chronic condition that causes painful cysts, which required multiple surgeries resulting in post- surgical and chronic pain for which she took opioids for years. Being on a high dose of opioids, Kathleen developed a tolerance to the medication and still had chronic pain. So she turned to me to work with her to find an alternative.

For Kathleen, a mother of two who works in finance, opioids were a valuable tool for post-op recovery and acute pain, but when she was on them long-term, she couldn’t function and wasn’t enjoying life. She wasn’t as involved in her children’s lives, and her work was suffering. I worked with Kathleen to help her manage her pain, so her life became positive and livable. We weaned her off all medication except for occasional ibuprofen for bad days. Now she goes to the gym, goes out with friends and enjoys life by going to her son’s baseball games and her daughter’s school plays.

Kathleen and I had a few difficult discussions. There were a number of red flags that concerned me such as missed appointments and pharmacists calling about prescriptions. I didn’t think opioids were right for her anymore and I was truthful with her. Having these difficult 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 and energetic again and is back to being successful in her career. She has her life back.

If you are taking opioids or your physician has prescribed them, as a pain medicine specialist, I suggest asking yourself (and your physician) some tough questions:

Why was I prescribed opioids?

• Some physicians 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 physician if other pain relief methods might be effective.
• If you and your physician 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 on opioids.” The opioids affected her relationship with her kids because she wasn’t as involved in their lives. That’s when she realized opioids were worse than the pain itself, motivating her to seek other options.

What should be 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;
• worry about developing a dependence or addiction 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 these concerns or others. It’s also important to ask about getting naloxone, a drug that reverses overdoses, if injected quickly enough.

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 physician, 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.

These are the difficult questions that people like to avoid, but physicians and patients need to talk so the patient can get the most appropriate treatment. With all the tools we have, there is a lot more patients can do for their pain with their physician’s help. Kathleen’s entire outlook on pain management changed after a few difficult conversations with me. She has said, if she didn’t have a physician anesthesiologist on her medical team, she thinks today she would be very overweight, inactive, not part of her children’s lives and clinically depressed. She has described the difference in her life without opioids as the difference between night and day. Check with your pain medicine specialist, have those difficult conversations and see if you can find a better solution to your chronic pain.

Anita Gupta is an anesthesiologist.

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