The Consequences of Long-Term Opioid Use for Chronic Pain
Life can be better with the use of chemicals. Every year, I embark on chemical warfare in my rose garden. The bugs try to eat all of the first blooms and I try to kill all the bugs with chemicals. Most of the time, I win the war and have a bounty of colors and perfumes gracing my garden. This year, I learned that these poisonous potions can have some major consequences. After spraying, one of my prized plants immediately turned brown and sickly. Worst of all, the targeted pest is still in my garden.
Chemicals do not always live up to their promises. The same can be said of opioid pain medications like morphine, methadone, oxycodone and hydrocodone. Sometimes these chemicals have some serious consequences and can still leave a person in pain. Are these chemicals really worth it in the long run? Was the loss of one rose bush worth the blooms of the others? I am not sure, but I am definitely having second thoughts about using chemicals in my garden knowing the consequences.
When severe pain strikes, the use of an opioid pain medication can be a nice honeymoon away from the pain. Unfortunately, honeymoons come to an end and the marriage continues, maybe or maybe not in wedded bliss. Year after year, the tolerance and dependency on the pain medication can grow, yet the pain remains. If the effect of the medication only last for six hours, then the body quickly becomes conditioned to take the pills every six hours. Pretty soon, this wedding ends up on a roller coaster of frequent withdrawals because once the pill wears off; the body physically thinks it will die unless more chemicals replace the stuff that just wore off. And that is one consequence of long-term opioid use, a roller coaster of physical dependency and withdrawals.
The consequences do not stop with opioid chemical dependency. After years of use and a frequent cycle of withdrawals, more pain can develop. Yes, long-term opioid use can cause more pain. How? Specifically, the nervous system can become more sensitive to painful stimulation. This phenomenon is called opioid- induced hyperalgesia. The nervous system becomes hypersensitive because of physical changes to the way pain signals are transmitted. These changes essentially turn-up the volume on the painful tune. With more nerve pain, more sensitivity to movement, more burning pain, and more medications needed to control the pain; opioid use starts to backfire by causing pain, instead of relieving pain.
What about the collateral damage from the long-term use of opioids? Yes, this chemical war on pain can harm other parts of the body. For starters, the production of sex hormones can nearly stop. Especially men need to be concerned about plummeting levels of testosterone, a condition called opioid-induced hypogonadism. Low libido is just a minor nuisance compared with the fatigue and depression caused by this hormonal imbalance. Other hormones are also disrupted by the long-term use of opioids like thyroid hormones and cortisol. In fact, the entire hormonal system can be severely impacted by the use of opioids.
And that is a consequence that should not be taken lightly because a domino effect starts from hormonal imbalances that then impacts other systems like the skeletal system. In fact, the long-term use of opioids is known to cause osteoporosis. Where else do these harmful dominos start to fall? Opioid induced hormonal imbalances are also highly likely to cause emotional imbalances, sleep disruption, metabolic changes, and cardiovascular stress. Over the past decade with more widespread, longer-term use of opioids, we are just now discovering the seriousness of these consequences.
Despite the consequences, everyone has to tend to his/her own garden. Choosing to use chemicals is a personal choice that only the gardener can make. Like all chemicals, the opioid chemicals come with a certain set of risks. These risks start with a roller-coaster of chemical dependency that can then lead to more pain and multi-system disruption. Sometimes these risks are not worth it especially if the pain is still there, disrupting life. For others, these medications are essential for having some quality of life. Personal decisions to use chemicals are based on individual circumstances. What did I decide about using chemicals in my garden? Based on my experience, I have chosen to be as chemically free as possible.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.