Ask an Expert: Should I Just Say No to Opiate Painkillers?

By Dr. Richard Juman 08/01/16

Professional Voices' Editor Richard Juman answers a reader's question on whether opioids are an appropriate treatment for chronic back pain.

Ask an Expert Should Opiate Painkillers Be Avoided at All Costs?
Just say no to the doctor?

Dear Expert,

Over the past six months I have developed lower back pain that seems like it is here to stay. My doctor was willing to prescribe opiates for me, but I was wary. I don’t have a history of addiction but I’m concerned that if I start I might be heading down a bad road. On the other hand, the pain is interfering with my normal activities, including sometimes interrupting my sleep. What do you suggest?

Dr. Richard Juman: I appreciate your question, especially as you find yourself in a situation that many Americans are also confronted by.

Twenty-five years ago it was extremely unlikely that your doctor would have recommended an opioid pain reliever. Back then, opioids were generally reserved for acute (for example, post-operative) pain episodes, cancer victims and people at the end of life. That was before a variety of forces, most prominently the pharmaceutical manufacturers who produced oxycodone and other opioids, convinced physicians that pain was the “5th Vital Sign” and that so-called “non-addicts” like yourself wouldn’t develop addictions to these medications. The prescribing of opioids for chronic, as opposed to acute or terminal, pain is a major causative factor in connection to the opioid epidemic. And in many cases, people are left with an addiction to opioids when the initiating, underlying cause of the pain is no longer an issue.

We now know, as evidenced by the widespread opioid epidemic, that many people without histories of substance misuse do become addicted to prescribed opioid painkillers. Additionally, a phenomenon known as “hyperalgesia,” in which patients wind up with a lessened ability to tolerate pain, can result from the long-term use of opioid pain medications. So my recommendation would be to address the underlying cause of the pain, if possible, and to utilize other strategies of pain management. 

Fortunately, there are many alternative approaches to pain management that have strong evidence of efficacy in clinical research and in the community. There are really too many to mention here, but look into chiropractic care, acupuncture, massage therapy, biofeedback, yoga and Tai Chi, to name a few. Additionally, there are many evidence-based psychological approaches to pain management available, including guided imagery, hypnosis, biofeedback, mindfulness meditation and progressive muscle relaxation. Many of these approaches have shown good results in the alleviation of back pain specifically. Ask your doctor for recommendations, but also ask your friends and colleagues—it’s not hard to find people who have achieved good results with alternatives to opioids for the alleviation of chronic pain.

Richard Juman is the Editor of Professional Voices, a weekly feature on The Fix designed to provide a forum for addiction professionals to discuss critical issues in addiction theory, treatment, policy and research. He is also a former president of the New York State Psychological Association and a longstanding member of its Addiction Division Executive Committee.

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