https://www.medpagetoday.com/blogs/themethodsman/71556
https://www.medpagetoday.com/neurology/painmanagement/71495
https://jamanetwork.com/journals/jama/article-abstract/2673971
The study compares using opioids versus non-opioids for chronic back pain and hip or knee osteoarthritis pain. Both the opioid group and the non-opioid group had similar reduction in pain, but the opioid group had more adverse reactions (although “fortunately no opioid abuse was detected”).
Both my sons are athletes. I’ve told them they’ll never take an opiod for any reason. Pain can be managed without them. It’s just not worth the risk.
I think above just points to fact that it’s generally better to start conservatively before moving on to procedures/medicines that come with increasing risks/side effects.
For ANY reason? How are you going to control this when they are adults making their own decisions?
I agree that in general, using opioids for CHRONIC pain might well be a path leading to trouble. Prescriptions of strong narcotics for relatively minor procedures are unwise. Not considering the risks of refills of prescriptions which really shouldn’t be necessary given the procedure/condition is reckless. I’ve had decades of back and neck issues and have never requested narcotics to manage this chronic condition. But there are many appropriate uses for opioids in the short term which do not doom the patient to addiction.
Anyone who has ever had a major abdominal surgery has likely found that early postop, non narcotic pain relief simply cannot do the job. Other painful surgeries can also require short term narcotic treatment. There are ways to properly use narcotic pain medications that ease suffering and reduce the adverse effects and abuse potential. If narcotics are combined with non-narcotics, less of the narcotic is required and the patient can usually wean off the narcotic earlier and more successfully. But be careful of saying “never,” because that may cause unnecessary suffering. Pain cannot ALWAYS be managed without opioids.
My daughter had a bone tumor -I can’t imagine her not having narcotics for post op pain relief. Withholding them would have been criminal for the first 48 hours.
These studies were done for chronic non-cancer pain in surgeries and conditions where inflammation is a huge factor. I So anti-inflammatory drugs are better for this purpose rather than opioids. As Nrdsb4 says, you’ll need some narcotic help for other types of surgery (like abdominal).
@Nrdsb4 Although I’m guilty I agree with you on the use of absolute terms (eg always, never, ever, etc). Situations can change depending on nature of procedure and very often the patient’s post op reporting.
My surgeon told me I would be on opioids for three months after my lumbar fusion surgery. I was determined not to use them. After all, I never used them after two C-sections and an appendectomy, so I was confident I could make it on Tylenol. Anti inflammatories were out of the question because the inflammation is necessary to help the bone fuse.
My pain was so severe that many times I sat and watched the clock until I could take my next dose of opioids. They barely took the edge off the pain. It took five weeks until I could graduate to Tylenol. Lesson learned.
I should add that the surgeon moved my spine and most of the pain was due to disturbing muscles and nerves.
I’ll take the relatively low chance of becoming addicted to pain killers over going into shock because of pain.
This is the problem with the opioid discussions as they stand now. The vast majority of people never get addicted to them but the rhetoric and fear makes it sound like everyone’s getting hooked off one drug.
True. And a lot of people who say “I would never take them. I have a high pain tolerance, I do fine with Tylenol,” etc. have never actually had a condition or surgery which involves severe to excruciating, intractable pain.
Let’s not mix up acute pain and chronic pain.
Opioids are very important and useful in the treatment of acute pain. Where they fall short is in the treatment of chronic pain.
I know parents who have refused to fill their children’s opioid prescriptions after the child had oral surgery – an acute pain situation. In my opinion, this is unnecessarily cruel. The use of opioids for a few days after that type of surgery is appropriate, and Tylenol is not an adequate substitute.
I took opioids (of gradually decreasing strength) for three weeks after badly breaking my leg (a tibia plateau fracture for which I had surgery to put in a plate and screws). They were necessary. I didn’t abuse them. I didn’t get addicted. This was 11 years ago, and I haven’t taken an opioid since. Nor do I have any desire for them.
At one point during my recovery from the leg fracture, my husband told my orthopedic surgeon that he didn’t want me on the opioid because it was addictive. The doctor laughed in his face. There are times when opioids are appropriate, and this was one of them.
This is true, but in certain circumstances, even chronic pain syndromes require some level of opioid use. People who have very severe chronic pain can become suicidal over time, because their pain zaps every bit of joy out of their lives. Sometimes you just have to make a risk/benefit decision that while not ideal, is better than any other alternative.
It would be great if a “miracle” drug could be developed that could eliminate severe pain without causing the adverse effects. One can keep hoping.
I’ve been in severe enough pain from a chronic condition that I would take my own life rather than live with that pain every day.
“This is true, but in certain circumstances, even chronic pain syndromes require some level of opioid use. People who have very severe chronic pain can become suicidal over time, because their pain zaps every bit of joy out of their lives. Sometimes you just have to make a risk/benefit decision that while not ideal, is better than any other alternative.”
And I know one such person. A military guy who was too stoic for his own good. His wife was on verge of divorcing him because of his depression and personality change. She couldn’t figure out what was wrong with him.
After some digging, it turns out he’d been living with severe chronic pain for a long time but refused pain meds.
Chronic pain will literally zap the serotonin in your brain and cause depression. She dragged him to the doctor immediately for treatment. (They’re still happily married BTW)
@timetoshine , try having two ribs cut off and pulled out through your armpits and then tell me whether Tylenol alone works!
I’m as leery of opioid addiction as any parent, but sometimes these drugs are necessary. The key is to use them only when nothing else works, and then to switch to a less addictive pain reliever as soon as possible.
I agree with @romanigypsyeyes here. These all or nothing, the sky is falling attitudes about opioids (and, IMO, marijuana) don’t help people sort out the facts to make rational decisions.
I used to do pain management in our hospital through the use of pain pumps (mostly following surgery). A patient was essentially in control of his own pain management.
Directions: Push the button when you feel you need it. Don’t wait until you are in real pain.
Push the button about 10 minutes before a lot of activity coming up.
. Staying out of pain ( small doses more often) is crucial since it takes a LOT more drug to get out of pain than it does to maintain a pain-free state.
But JUST knowing you can get out of pain on your own time (without waiting for the clock or a nurse) resulted in FAR less opioid use. We had patients who never hit the pain button at all–but were so happy and comforted to have that option–just having control was enough.
Someday we’ll solve the riddle of addiction. It’s fascinated me for a long time. How can one person quit an addictive drug basically cold turkey and someone else is hooked a first time?
"Romani: I’ll take the relatively low chance of becoming addicted to pain killers over going into shock because of pain.
This is the problem with the opioid discussions as they stand now. The vast majority of people never get addicted to them but the rhetoric and fear makes it sound like everyone’s getting hooked off one drug. "
I think this is the first time we have ever agreed about anything. 
You are SO RIGHT. Who the heck cares about some remote possibility of a potential habituation in the future when there is a painful emergency right now.
I had a sister who died in her early 20s. She had a number of very serious issues, and I remember her being told this nonsense. It made me angry at how she was treated. Some of what happened to her was the result of medical error yet they wanted to treat her as some future potential addict. She was dead in a couple of years anyway. Complete nonissue.
Personally, I have had abdominal surgery and had to get off the hydrocodone almost immediately, because I could not tolerate the side effects. But still happy to know I had it if I needed it.
"Gouf78: But JUST knowing you can get out of pain on your own time (without waiting for the clock or a nurse) resulted in FAR less opioid use. We had patients who never hit the pain button at all–but were so happy and comforted to have that option–just having control was enough. "
Exactly!
As a double boarded physician in anesthesiology and addiction medicine, I would encourage more studies like this one. However, I think the researchers are minimizing a critical flaw with their study. First, it’s a small sample, but the biggest issue I have is the fact that more than 10% of the non-opioid cohort were actually on the opioid tramadol. So this study should have been hailed as demonstrating that escalating opioids beyond tramadol is equivocal.
Opioids are toxic drugs that have limited benefits beyond trauma or surgery. However, I don’t experience the pain that my patients report. Thus, through counseling, trial and error, regenerative medicine, etc. someone in pain MIGHT avoid opioids but the option shouldn’t be denied. Too often, my colleagues throw pills at their patients and that practice continues despite the opioid overdose epidemic. Too many of my patients began their addiction with their first dose. So, starting opioids should NEVER be taken lightly.