Narcotic medications in pain management

June 11, 2015

In recent decades, narcotic medications have been widely used outside hospitals for managing pain. In Australia the prescription of narcotics for chronic pain in the community has escalated over the last 10-15 years. Prescription levels now seem more stable.

The term “narcotics” refers to opioids (morphine-like) drugs. Drugs related to morphine include codeine, fentanyl, hydromorphone, pethidine, oxycodone and tapentadol.

There are so many different names for these drugs that some people aren’t aware they are taking a narcotic for pain.

Over the last 5 years, consistent evidence has accumulated showing that narcotics are not effective in improving pain or quality of life in chronic pain. There is still no argument that these agents are a blessing in hospital after operations, and for acute (short term) pain problems.

Essentially, the benefits seem to “wear off” but side effects accumulate – especially as doses are increased.

In summary the conclusions from recent research indicates:

  1. Narcotic medications only improve pain symptoms short-medium term.
  2. Narcotic medications don’t improve pain levels of quality of life in the long-term (over 12 months) – infact quality of life may deteriorate.
  3. There are severe complications from long-term (over 12 months) narcotic usage especially in high doses. There is even an association between narcotic doses and death rates in some studies.

This has prompted most pain clinics to focus on teaching people ways to manage pain without narcotics, or with reduced narcotics. The Hunter Integrated Pain Service at Hunter New England Area Health Service makes the following recommendation:

“Existing evidence does not support the long term efficacy and safety of opioid therapy for chronic non-malignant pain”

This means they recommend against using narcotics (opioids) for chronic pain.

A lot of patients referred to us are using narcotics to help cope with pain. At NIPM we regard it as a priority to help people find better, safer strategies for managing pain. Multidisciplinary strategies like exercise physiology, pain psychology, and sometimes procedural pain medicine can be very helpful.

For further information you can:

(1) Discuss this issue with the team from NIPM

(2) Visit the Pain Management Network website at: http://www.aci.health.nsw.gov.au/chronic-pain/for-everyone/pain-and-role-of-medications

This site has excellent easy to understand information on the role of medications in pain management.

(3) This is an excellent presentation on using narcotics for chronic pain (see below):

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