Opioids aren’t for everyone. In fact, they’re often reserved for patients with severe pain from terminal cancer.
“We prescribe opioids only when other treatments and pain medications don’t work,” says Benjamin Abraham, MD, of Cleveland Clinic’s Department of Pain Management. “Because of the challenges that can come with using opioids, patients who take them require careful monitoring and regular follow-ups.”
One of the biggest challenges is risk of abuse. Opioids are highly addictive. In the past decade, the number of deaths from painkillers, including opioids, has quadrupled to nearly 15,000 per year in the United States.
But even when used as prescribed, opioids can cause unwelcome side effects including:
Constipation. Constipation is the most common side effect of opioids, affecting up to 90 percent of patients, according to one study. It can set in almost immediately, after only a day or two of opioid use. Complications can range from uncomfortable hemorrhoids to life-threatening bowel obstruction. That’s why most patients on opioids are advised to take stool softeners, laxatives or both.
Hormone imbalance. Opioid use often causes low levels of testosterone or estrogen, the male and female sex hormones. People may experience erectile dysfunction, reduced libido, fatigue, hot flashes, menstrual irregularities, low energy, weight gain and depression. And hormone imbalance can lead to more serious complications, such as infertility and osteoporosis.
The best resolution is to stop taking opioids. Another option is hormone replacement therapy, although estrogen replacement in women sometimes brings other medical concerns.
Worsened pain. It may seem ironic, but opioids can actually intensify pain in some people — sometimes within minutes of taking the drug. The reasons aren’t clear. People with this side effect are either transitioned to a different drug or weaned off opioids altogether.
Weakened immune system. Your body’s ability to fight off infection weakens immediately upon taking opioids, even if you don’t get sick for months later. With no tried-and-true way to boost immune function, the best way to manage this side effect is to stop taking opioids.
Depression. Studies show that about 10 percent of patients using opioids develop some kind of depression. If discontinuing opioids isn’t preferred, antidepressants may help.
“These side effects are not limited to people who abuse opioids or have been taking opioids long-term,” says Dr. Abraham. “They can occur in anybody — even patients who just started an opioid regimen.”
That’s why opioids should be used cautiously and only as a last resort.
“For those struggling with chronic pain, pain management specialists can offer an array of other treatment options with fewer if any side effects,” says Dr. Abraham.
Dr. Abraham sees patients at Marymount Hospital and Elyria Family Health Center. To make an appointment with Dr. Abraham, call 216.444.PAIN (7246).