May 15, 2023

Opioids: the best way to manage pain?

opioid report
Opioids are substances that act on opioid receptors and are primarily used for pain relief, including anesthesia. [Source: Shutterstock]

Key points:

  • Opioids such as morphine and oxycodone are frequently prescribed to older people suffering from chronic pain related to arthritis, urinary tract infections, circulatory problems and other health issues 
  • There are more risks for older people who take this medication including heightened pain sensitivity, increased risk of falling and confusion
  • There are other options available for older people who wish to seek non-pharmacological treatments like acupuncture and physiotherapy

The conversation around opioids, their place in medicine and prescription best practice has been debated for many years, particularly for older people living with chronic pain. 

A new report from the National Drug and Alcohol Research Centre which found that there were 1788 drug-induced deaths Australia-wide in 2021 from semi-synthetic pharmaceutical opioids including morphine and oxycodone. The Royal Australian College of General Practitioners (RACGP) has called on the Federal Government to end the pointless “war on drugs” and act to save those living with opioid dependency.

Despite this statistic, opioids are often prescribed to older people to manage chronic pain conditions such as arthritis, fibromyalgia, urinary tract infections and circulatory issues despite their addictiveness and high risk of side effects.

RACGP Chair of Specific Interest Addiction Medicine, Doctor Hester Wilson, said the medical field needs to move away from considering opioids as a long-term treatment for older people with chronic pain as they are often on multiple medications that could react badly.

“Not everybody is the same, but many of my older patients are very trusting and if I give them a medication they just take it so for older people living in the community, it’s really important to take a look at your medicines, have conversations with your GP and pharmacists and look at what risks are associated with your medicines.”

What are the risks of opioids?

For elderly people, overdose is a risk like it is for everyone else but being more susceptible to side effects, their independence and safety are in equal jeopardy. 

Often, older people have more than one medical condition or ailment they need assistance with, sometimes older patients can slip through the cracks of our medical system where specialist recommendations aren’t communicated to their GP and confusion around medications occurs. 

If multiple sedative medications are being taken at once, there is a risk that the respiratory centre in your brain becomes depressed, causing you to stop breathing which can then lead to heart failure.

Side effects of opioids also can lead to increased risk of confusion and falls which impacts an older person’s ability to live alone. This often means they are placed in an aged care facility earlier than expected.

One of the more distressing and ironic symptoms of opioid use is a heightened sensitivity to pain which often prompts requests for an increased dosage. But Dr Wilson said this is not the best practice.

“With my older patients, I’m looking at if we can get that dose down. I do understand though that it takes time and people do get very scared they’re gonna be left in terrible pain.

“It’s this catch-22 of medication and pain sensitivity as you drop the dose down. I always do this really slowly and explain really clearly [that] we’re in this together.”

Dr Wilson explained that while it is likely patients will experience a bit more pain as the dosage is dropped, but the body will recalibrate and the pain will be better.

There is also a proven psychological element in chronic pain with its severity linked quite closely with a patient’s feelings about their conditions and medications. 

older person looking at medication
Dr Wilson explained that patients can develop depression and anxiety from chronic pain and should be supported with the help of a mental health professional. [Source: Shutterstock]

How you think about the pain, how you conceive it and your psychological response to it impacts the long-term management of pain so support from a mental health professional should be considered in your treatment plan. 

Being active in your pain journey

Many older people are stoic in the face of pain and don’t like causing ‘trouble’, meaning they often follow the advice of doctors whether they are comfortable with it and informed about it or not. With this in mind, it is important to help arm older people with the knowledge they need about medications and treatment options so they can make informed decisions about their pain management.

Doctors and specialists can provide brochures or print off information about the medications they prescribe but the internet is a good place to read not only evidence-based information but anecdotes from other people who have written about their experience with opioids. 

Dr Wilson explained that understanding the nature of chronic pain is vital in managing the condition and feeling empowered enough to push for other treatment alternatives to opioid use.

“One of the really important things is understanding what chronic pain means, what the signals mean and that it is a complex condition,” she said.

“For example, many think that if you walk on the pain or move it that you’re going to harm yourself. It’s important to keep moving. Physical activity is really important and that psychological mindset of ‘I can do this – I’m going to go for a gentle walk, I’m gonna be in a little bit of pain, but I can manage it’.”

Opioid alternatives

There are a number of non-pharmacological options to treat chronic pain and more doctors should be advocating for these options to their older patients – something our system fails to do consistently. 

Some other non-pharmacological treatments include:

  • Acupuncture 
  • Remedial massage 
  • Exercise and movement, either alone or with a physiotherapist

Are opioids in your long-term treatment plan? How do you feel about this type of pain medication? Let us know in the comments. 

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