Q and A: Should I Take Opioid Pain Medications? Pseudoaddiction, Anxiety Disorder

Yes, if you are suffering with acute or chronic pain you should take pain medications.

Acute pain lasts for less than 3 to 6 months and chronic pain lasts for more than 6 months.

Pain following surgery, injury or fractures are acute pain and may not last beyond 3 to 6 months. Severe pain is treated with opioids for first 7 to 10 days and then pain is treated with anti-inflammatory medications (NSAIDs). Mild to moderate acute pain is treated with NSAIDs only with muscle relaxants if necessary.

Mild to moderate chronic pain is treated NSAIDs. Severe pain is treated with opioids and adjuvant pain medications.

Chronic pain is often associated other symptoms like muscle spasm, neuropathic pain, anxiety and depression. Adjuvant medications are prescribed for symptoms other than pain symptoms.

Chronic pain is divided in to nociceptive or neuropathic pain. Nociceptive pain is continuation of acute pain mostly cause by inflammation, infection like osteomyelitis, fracture and non-healing surgical wound. Neuropathic pain is characterized as burning pain with hyperalgesia, allodynia and hyperpathia. Neuropathic pain is caused by abnormal exchanged of information of pain in spinal cord and brain.

No, opioids are avoided in neuropathic pain. Neuropathic pain is treated with antidepressant analgesics like Cymbalta and Elavil or antiepileptic analgesics like Neurontin or Cymbalta.

Neuropathic pain does respond to opioids. Opioid is unable to block the neuropathic pain impulses passing to brain at the spinal cord. Patients often consume lot more pills than prescribed dosage of opioids to get optimum pain relief. Rapid and excessive consumption of opioid causes increase resistance and tolerance to opioids resulting in either dependence or addiction to opioids.

No, unless you had taken opioid in the past and had addiction problems. If you are taking pain medication or street drugs while taking prescription opioid medications, then you are already in addiction and opioid treatment will make the symptoms of addiction worst.

Yes, you could be addicted to opioids if you have genetic addiction abnormalities. Patients with addiction behavior often smoke, gamble and take narcotics or street drugs. Since you had never taken opioids and if you do not have any other addiction behavior you may never be addicted to opioids.

No, you can discontinue your treatment anytime you decide and switch to other pain medications. Most of the patients prefer to taper (reduced) dose of opioids and add NSAIDs pills. You can replace or discontinue opioids in 3 to 4 days.

Yes, post surgical pain and fracture pain remain severe even after 10 days. Severe pain may not respond to NSAIDs or any other pain medications. You may be benefited with opioids until pain intensity is less enough to be treated with NSAIDs.

No, you should continue opioids until pain intensity is tolerable and then switch to NSAIDs. If you have difficulties to discontinue opioid in spite decrease in pain intensity then you may be dependent on opioids. In that case you may need to see pain specialist and psychologist.

Opioid dependent is a condition where your pain relief depends on blood level of opioids. Opioid dependent is also known as Pseudoaddiction.

Pseudoaddiction is seen in anxious patient with low pain threshold. Anxious patient with lower pain tolerance will feel mild pain as a severe pain when opioid level in blood comes dawn from optimum level. Obviously patient will consume opioid out of fear of pain. You will need to see pain specialist and psychologist to correct you pain tolerance and behavior.

If you are dependent on pain medication as in Pseudoaddiction you will run out of pain medications. You will have to see a Pain Specialist and Psychologist. Correct your problems with adjuvant medication and antianxiety medications.

No, you are not suffering with anxiety disorder just because you have anxiety of pain. Being anxious does not mean you are suffering with anxiety disorder. Patient with anxiety disorder need a psychiatrist to diagnosed and treat the disorder.

If you are taking opioids for pain as prescribed by your physician and not running short of pain medications at the end of the month you are neither addicted or dependent on pain medications. If you have extra pills left at the end of month then you should reduced the number of pills per day by one and eventually come off the opioid pain medications.

Opioid blocks the pain receptors located at peripheral tissue and spinal cord. Pain impulses are unable to pass forward to brain once receptors are blocked. Continuous opioid therapy causes physiological changes of receptors resulting in increased tolerance and resistance to opioid effects. Receptors do not respond to opioids and opioid therapy may not be useful to relieve pain. Most of the patient feels the need of increase dosage to achieve pain relief. Rapid increased of opioid dosage is not safe.

Long-term opioid consumption has few side effects and may not be safe. Long-term consumption of opioids causes severe constipation. Accidental high dosage or continuous over consumption of opioids causes higher blood concentration of opioid, which results in severe respiratory depression. Several reports have been published of death caused by opioid induced respiratory depression and apnea (unable to breath).

Yes, you should take opioid for chronic pain when necessary. An experience pain specialist should supervise opioid treatment. Long-term opioid therapy is essential in certain chronic diseases, but there will be minor or major life threatening complications. Long-term opioids therapy should be avoided in neuropathic pain.