Manage Opioids

Managing Opioids

When you have chronic pain, opioids, like hydrocodone or morphine, sometimes help. But these pain meds have serious safety concerns and require very careful monitoring. If you take them, track their effect on pain and note side effects in a journal. 

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments:

Categories: Treatment

Duration

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Discuss Opioids

If you are not getting relief from pain and have tried several types of pain meds, ask your doctor whether the short-term use of an opioid would be appropriate for your pain. Some commonly prescribed ones are: 

  • Codeine (only available in generic form)
  • Fentanyl (Actiq, Duragesic, Fentora)
  • Hydrocodone with acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  • Hydrocodone (Zohydro ER, Hysingla ER)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Astramorph, Avinza, Kadian, MS-Contin, Ora-Morph SR)  
  • Oxycodone (OxyContin, OxyFast,, Roxicodone)
  • Oxycodone with acetaminophen (Percocet, Tylox, Roxicet)
  • Oxycodone and naloxone (Targiniq ER)

Keep in mind that many doctors are reluctant to prescribe them due to addiction risk, side effect concerns, and lethal risk with overdose. In addition, while opioids can sometimes be helpful for certain types of pain, like joint or bone pain, there is debate among doctors about whether they are helpful for other types of pain, such as nerve pain, herniated disks, and pain from multiple sclerosis, for example. Long-term use of opioids also is generally not recommended in people with a history of alcohol or drug abuse.

Prompt: What's an opioid?

CTA: Understand the concerns.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers: 

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Opioid Decision Time

To evaluate any treatment, your doctor determines whether its benefits will outweigh its risks of side effects. Specifically, strong benefits include:

* Significant increase in functioning

* Elimination or reduction of pain

* More hopeful and positive attitude

The risk of side effects should be minimal or controllable.

Listen to what your doctor says and ask questions. Depending on your type of pain, the drugs you take, and other factors, opioids may or may not be the best choice for you.

Prompt: When to opt for opioids?

CTA: Balance risk and benefit.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

When Opioids Help Most

Opioids work best for certain types of pain. They blunt the intensity of pain signals reaching the brain and calm the brain's response to them. Doctors may be more likely to use them when:

* You have a flare up of severe pain

* Other treatments haven't worked

* You're starting treatment for severe pain -- opioids can control pain while you're waiting for other treatments to take effect.

Prompt: When do opioids help most?

CTA: Treating flares.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Opioid Cautions

Your doctor may be able to help you manage side effects. Common opioid side effects include constipation, drowsiness, nausea, dizziness, lightheadedness, or feeling faint. Call your doctor if side effects get worse or you notice mental or mood changes, severe abdominal pain, or difficulty urinating. 

Seek emergency medical care for rare but serious side effects such as:

* Severe allergic reaction

* Fainting

* Seizures

* Slow breathing

* Unusual drowsiness

* Difficulty waking up

Prompt: Opioid cautions.

CTA: Watch for opioid side effects.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Appropriate Opioid Use

Taking an opioid exactly as prescribed for pain helps minimize the chance of addiction and side effects. Use the drug exactly as directed and take no more than the amount prescribed. Don’t get opioids from more than one doctor or use them for reasons other than treating physical pain. Make sure you understand the risks clearly.

Prompt: Prevent opioid abuse.

CTA: Share your medical history.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Opioid Withdrawal Symptoms

If you want to take less or stop using opioids, ask your doctor to help you slowly decrease the dose so your body can gradually adjust. If you've been taking opioids for a long time, you may experience withdrawal symptoms such as sweating, nervousness, and diarrhea if you suddenly take a lower dose or stop taking them completely. This is not necessarily a sign of drug addiction. Some medications lead to withdrawal symptoms when stopped abruptly. Withdrawal symptoms from long-term opioid use can be uncomfortable, but are not dangerous.

Prompt: Withdrawal symptoms?

CTA:  Effects of long-term use.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers: 

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Loss of Control

Some people who take opioids on a long-term basis develop tolerance to the drug -- requiring a higher dose to achieve the same effect. That can sometimes lead to misuse of the opioid, such as taking more than prescribed or using it for reasons other than pain relief.  

Addiction also develops in some people. Those with a history of alcohol or drug addiction are at especially high risk for opioid abuse. Signs of an opioid addiction include an intense craving for the drug, taking more than is prescribed, hoarding drugs, and experiencing relationship difficulties or problems at your job related to opioid use. If you recognize signs of addiction in yourself or have concerns, get help and advice from your doctor.

Prompt: Loss of control?

CTA: Learn signs of opioid addiction.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers: 

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Opioids Can Backfire

Taking opioid drugs for a long time may sometimes increase sensitivity to pain. New research finds that for some people, being on these drugs for long periods at high doses can actually change the nervous system in a bad way. Along with increasing sensitivity to pain, you may develop a tolerance to opioids over time where a higher dose may be required to achieve adequate pain relief. Discuss these pros and cons with your doctor.

Prompt:  Long-term opioids?

CTA:  Know the downside.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers:

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Common Opioid Side Effects

One common side effect of using opioids is constipation. You can help prevent it if you:

* Eat more raw vegetables, fruits, and whole grains

* Exercise daily

* Drink 8 to 10 glasses of water a day

* Ask your doctor if it's safe to use a stool softener or laxative

Keep in mind that common fiber supplements may not help with constipation related to opioids. However, there are prescription drugs specifically designed to relieve constipation related to opioids.Check with your doctor before using any laxative.

Prompt: Backed Up?

CTA: Prevent opioid constipation.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers: 

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

Prevent Fatal Errors

It's not safe to break, cut, chew, dissolve, or crush certain types of opioid pills before taking them. Breaking or crushing pills can sometimes lead to a potentially fatal dose of the medication. Don't alter opioid medications in any way before you take them. If you have problems taking whole pills, talk with your doctor.

Prompt: Don't crush pills.

CTA: Take pills in whole form.

Conditions: Rheumatoid arthritis, osteoarthritis, fibromyalgia, back pain, neck pain, migraine, nerve pain, undiagnosed

Symptoms: stiffness, stiffness after rest, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, difficulty walking, limp, neck stiffness, pain at night, all over pain ankle pain, buttock pain, elbow pain, foot pain, finger pain, hand pain, hip pain, jaw pain, knee pain, neck pain, shoulder pain, wrist pain, symptoms worse in evening, lower back pain, upper back pain, tenderness, jaw pain, aching , burning, headache, tenderness, insomnia, migraines, back of head pain, buttock pain, rib pain, scalp pain, skin pain, shoulder pain, thigh pain, shooting pain, stabbing pain, tender points, TMJ, pain with movement, sharp pain, shocking pain, leg cramping, arm cramping, electric pain, foot pain

Triggers: 

Treatments: oxycodone, methadone, morphine, fentanyl, Duragesic, hydrocodone, Norco, Vicodin, hydromorphone, Dilaudid, Exalgo, Astramorph, Avinza, OxyContin, Percocet, Roxicet

Categories: Meds

WebMD Medical Reference Reviewed by Sabrina Felson, MD on May 23, 2019

Sources

SOURCES:

American Chronic Pain Association: "ACPA Resource Guide to Chronic Pain Medication and Treatment."

Dworkin, R. Pain, Dec. 5, 2007.

University of Wisconsin Health: "Constipation from Opioids (Narcotics.)"

Medline Plus: "Drug Dependence."

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