HONOLULU (Sept. 26, 2018) -- It's Pain Awareness Month, which is an opportune time to consider and discuss various treatment options for pain. At times, over-the-counter pain medications may suit the needs of an individual, but then there are the times when stronger options, like opioids, are needed. Opioid addiction is a concern across the country; however, opioids do serve a role in pain management.

Dr. Diane Flynn, a primary care pain management advisor at Madigan Army Medical Center's Interdisciplinary Pain Management Center on Joint Base Lewis-McChord, Washington, answers questions about the appropriate use of opioids in pain management.

Q: How are opioids utilized when treating pain?

A: Opioids can be very helpful in the treatment of acute pain such as pain caused by traumatic injury or surgery when nonopioid therapies don't provide adequate relief. When used to treat acute pain, in most cases, opioids are recommended for only short periods of three to 10 days, depending on the severity of the injury or complexity of the surgery.

For chronic pain, however, opioids are not recommended because they do not provide better pain relief nor lead to better functional improvement than nonopioid therapies, yet have considerable safety concerns such as addiction and overdose that are not associated with nonopioid medications. A recent research study, which demonstrated that opioids do not provide better pain relief than other medications, is described in the journal article, "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain."

Depending on an individual's underlying pain condition, some classes of medications that may provide relief at least as well as opioids include nonsteroidal anti-inflammatory medications. Please consult your primary care provider for a complete list of these medications.

Q: What is tolerance?

A: Tolerance is a commonly experienced effect of opioids and some other medications. It means that the pain relief from a given dose of opioids tends to decrease over time, so that the person must take higher and higher doses over time to experience the same relief.

Q: What are some circumstances a person may become dependent on opioids?

A: Physical dependence is the phenomenon often observed with opioids and many other medications by which an individual who has taken a medication on a long-term basis will experience withdrawal effects if he or she stops or decreases the dose suddenly.

Q: What is addiction?

A: Opioid addiction, which is also called "opioid use disorder" is distinct from either tolerance or physical dependence. Opioid addiction occurs when an individual continues to take opioids even though it is harming them.

It is sometimes characterized by "the four C's:"
Loss of Control - taking more medication than instructed or intended
Craving - strong overwhelming desire to take opioids
Compulsion to take opioids
Use of opioids despite negative Consequences

Q: What are treatment options for patients who become addicted to opioids?

A: Opioid addiction is a serious medical condition which is highly treatable. It is important to seek care if you believe you or someone you love may have opioid use disorder. Treatment with counselling and/or medications can help to restore a sense of control in the life of someone struggling with addiction.

Editor's Note: This is the third in a three-part series of stories by Regional Health Command-Pacific's Directorate of Communication, about pain management in honor of Pain Awareness Month.