by Dr. Anita Gupta

Watch the key conversation patients should ask their physician before using prescription opioids for pain.

Opioids often are the go-to pain killer for everything from back aches and injuries to post-surgical pain, as evidenced by the more than 300 million prescriptions written each year. While they can be effective for moderate to severe short-term pain, opioids are not without risk.

As many are aware, opioid misuse and abuse has become an epidemic in our country. With more people being prescribed opioids, more are experiencing an increased tolerance to pain medication and must take even more to find relief.

Now we have a new problem – a new rise in heroin use and overdose. Policy, guidelines, innovations aside — patients are still suffering. What are doctors and patients to do?

As a physician, I have witnessed first-hand how patients can get frustrated if health care professionals deem their requests for opioids as unsafe or excessive. This creates a tense environment for those in the health care field, who are torn between exercising sound medical judgement and the compassion to alleviate patient concerns.

Policy may have the power to help with some of this by protecting doctor-patient time. This time spent talking is essential to communicating and discussing with patients innovations, new treatments, options, risks, alternatives, and can even involve family and caretakers who are critical to helping pain patients get better. Patients, too, should educate themselves about opioids and prepare to ask their physician some tough questions. Often it is the conversation between doctor and patient and careful deliberation with an ounce of time, that is often missing in healthcare, that can come to the right answer for many suffering in pain.

This happened recently with a patient of mine named Kathleen. She first came to me because she suffered from a chronic condition that caused painful cysts that required multiple surgeries resulting in post-surgical and chronic pain for which she took opioids for years. Despite being on a high dose of opioids, Kathleen still had chronic pain, and the medication was keeping her from enjoying her life. Together, we worked to find an alternative solution to managing her pain and weaned her off all her medication except for the occasional ibuprofen for bad days of pain. Having those initial tough conversations of determining what to do for her pain really developed trust between us so I could help her move forward and cope with her pain on those bad days. Since she’s been opioid-free she’s vibrant, energetic and successful in her career. She has her life back and it was not an easy road but we did it together slowly with careful conversations, trust, and must need patient-doctor time.

 So, what are these tough questions patients on opioids should ask their physician. There are much too many questions to ask your doctors when you start opioids from day one but here are just a few to get you on the started on day one:

1. What options exist to treat my pain other than opioids?

Patients should understand why they were prescribed opioids in the first place. Some physicians assume patients will demand what many consider the strongest and most effective pain relief and therefore prescribe opioids automatically. But there are many medication and non-medication options, so patients and their physicians should discuss if other pain relief methods might be effective. Alternative therapies could include injections or nerve blocks; electrical stimulation and spinal cord stimulation; physical therapy; acupuncture; biofeedback, meditation, deep breathing and relaxation; and in some cases, surgical procedures. Also, consider what options exist at the time of surgery before the pain even begins at all. New options and innovations may even change the course of pain all together and asking for the most comprehensive treatment options allows you to empower your health forward.

2. What are the risks of taking opioids?

With the media attention surrounding opioid risks, many people feel conflicted about taking them. They may worry they are being judged by others; be concerned about becoming addicted and/or potentially overdosing; and fear they won’t be able to control their pain if they stop taking opioids. It is important to understand the risks, discuss them and if you are taking them make sure you continue to know how to be safe on them as the concerns continue.

3. How might opioids affect my quality of life, and how do I stay safe on these medications?

Opioids have many side effects, ranging from severe constipation, mental fogginess and nausea to depression. Physicians are more than willing to discuss any concerns you might have about taking opioids and can discuss safety precautions, such as obtaining naloxone, a drug that can reverse an overdose if injected quickly enough. Naloxone is known antidote to opioid overdoses and it can be used to reverse an overdose rapidly.

Seeing patients suffer from something that is preventable is very disheartening, in addition to the added strain it places on the health care system. It is my duty as a physician to do my part in caring for the whole patient.

Learn more about the safe use of opioids by visiting www.asahq.org.

Anita Gupta is an anesthesiologist.