OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Mark Schlimgen, MD, DABPM

Use of Narcotic Pain Relievers

Mark Schlimgen, MD, DABPM
Pain Management
Pain Clinic of Northwestern Wisconsin
Eau Claire

Narcotic pain relievers (also referred to as opioid pain relievers) are commonly used in the treatment of severe acute pain. Their use, for post-operative pain or pain following injuries or associated with terminal cancer, is widely considered appropriate and acceptable in the medical community.

 The use of long-term narcotic analgesics (pain relievers) for chronic and non-malignant pain is more controversial. There is evidence in the medical literature that the use of long-term narcotics in non-malignant pain can be effective therapy in carefully selected groups. In these carefully selected patients,

there is evidence that low to moderate dose narcotic analgesics can be effective in pain control and can also lead to improvements in activity levels and productivity.

 Not all patients are appropriate for narcotic analgesia. Nor, can all pain be controlled by opioid analgesics. Addiction can occur in certain patients and opioids given at very high doses can have serious detrimental affects on the health of an individual.

 When considering a patient for long-term opioid analgesic use, multiple factors need to be considered.  First, successful management of chronic pain usually does not require the use of opioids. There are patients that cannot have pain managed with long-term opioids or that see very little improvement in their pain. They also may have too many side effects. There are patients that have difficulty in controlling their use of opioid analgesics. It should be understood that opioids by themselves rarely are effective, but should be used in combination with other medication and physical therapy and rehabilitation.

 The use of opioid analgesics is one treatment approach that can be selected by agreement between the patient and the physician. The patient is usually required to sign a narcotic agreement before proceeding with long-term use. This agreement outlines the rules necessary to obtain medications on a regular basis.

Candidates for long-term opioid use would include patients that:

  • have an established diagnosis that is associated with severe pain
  • are reliable and known to follow prescribing directions closely
  • have exhausted all other alternative treatment methods
  • are not abusing illegal substances or alcohol
  • are not pregnant or likely to become pregnant

Patients with daily pain will generally be prescribed long acting opioids. Those with episodic pain will generally be given shorter acting opioid analgesics. In both cases, the amount of medication given will be limited and tightly controlled.

Tolerance of opioid analgesics is a serious limiting factor to extended use. Over a period of months, most patients will experience levels of tolerance to the affects of the opioid analgesics. Frequent increases in the dose are not considered acceptable. A once yearly increase in medication may be offered if tolerance is viewed as a significant problem for the patient.  Large doses of narcotic analgesics are detrimental to patient health. Therefore, if an increase in medication is ineffective in improving pain control, discontinuation of the medication becomes a consideration.

Opioid analgesics are one potential choice for the treatment of chronic non-malignant pain. The use of opioid analgesics for chronic pain is neither a patient’s right nor a privilege. It must be a mutually agreed upon treatment option between the physician and the patient.

 ~  For information or to schedule an appointment with Dr. Schlimgen, Pain Clinic of Northwestern Wisconsin, call 888.235.7246 or visit www.painclinic-nw.com.
Dr. Schlimgen sees patients in Eau Claire and Rice Lake.