When the Centers for Disease Control and Prevention issued new guidelines for opioid pain medications earlier this year, it also opened up lots of concern for patients, including a woman we met at Arizona Pain in Glendale.
"If you are not abusing the medication, and it is helping you, why should it be stopped?" she wondered. But at the same time, she described an almost love/hate relationship with the powerful drugs. Sometimes they are the only things to ease pain from both a bladder disease and back problems.
"[For] one disease, it's almost easier to take over-the-counter medicine. For two, it's impossible," she said of efforts to totally cut out opioids.
The woman did not want to share her name. She worries that if people know she has the drugs, she could be targeted by thieves. It's not an unrealistic concern considering that drugs like OxyContin, oxycodone, Percocet and other opioids are among the most common prescription drugs diverted for illegal use.
"Morphine, which all opioids are derived from, is one molecular structure different than heroin," Dr. Jonathan Carlson, a pain specialist at Arizona Pain, explained. "So it is highly addictive, highly habit-forming."
Because of that, the drugs can also be deadly. Carlson said they were responsible for 165,000 deaths from 1999 to 2014.
For cancer or acute pain, opioids are still recommended. But for people who use them long-term for chronic pain, the risks go up.
"The danger long-term is you actually become tolerant," Carlson said. "So you actually need more medications as we go along."
That is the area the new guidelines focus on -- prescriptions for people with chronic pain. Opioids are not recommended as the first choice.
"We want to take a look at alternatives such as physical therapy, injections, spinal cord stimulation -- different things to try and treat the pain and maybe fix the problem as best we can," Carlson said.
The patient we spoke with said some of those alternatives -- steroid injections and another procedure called radio frequency ablation -- actually did give her some relief. Still, while she would prefer not to use them, she said sometimes nothing will help but opioids.
"I try to get ahead of the pain, because, if I wait an hour or two hours after the pain is bad, then I am down," she said.
If opioids are used, the CDC says doctors should go with the lowest dose possible, and use them in conjunction with other pain drugs like anti-inflammatories.
Carlson says he realizes that for people who have been taking opioids, the thought of cutting down can be frightening, which is why he walks through the facts about actual effectiveness.
"The evidence they saw did not show that for long-term it was very helpful for patients," he said.
He also addresses the risks.
"I think the biggest thing is patient education," he said. "I say, 'Look, the opioids are not only highly addictive and deadly at higher doses, but they also can cause endocrine deficiencies, decreased energy, decreased sexual function, increased fatigue, decreased muscle strength.' In some severe cases, there is discussion about immune suppression. And there is evidence they cause increase in tumor cells. And so these medications are not benign medications."
Carlson believes those are all good reasons to try alternatives if possible. Our patient agreed.
"People shouldn't be afraid to manage it, and try the alternatives," she said.
You can take a closer look at the new guidelines at CDC.gov.
For more information about Arizona Pain, check out ArizonaPain.com or call 480-845-0816.Copyright 2016 KPHO/KTVK (KPHO Broadcasting Corporation). All rights reserved.