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Inadequate pain management is common in surgical wards, critical care units, and emergency rooms, as well as in general practise, the management of all types of chronic pain, including cancer pain, and end-of-life care. This neglect affects people of all ages, from newborns to the elderly who are medically weak [9]. In the United States, African and Hispanic Americans are more likely than others to suffer unnecessarily while under the care of a doctor [10] and women's pain is more likely than men's to be undertreated.

Opioids are a class of narcotic painkillers. If you don't use them correctly, they can have major negative effects. People who are addicted to opioids frequently began their addiction with a prescription.

If you need to take opioids to regulate your pain, there are a few things you can do to be sure you're doing it safely.

What Are Opioids and How Do They Work?

Drugs that bind to opioid receptors in the brain, spinal cord, and other parts of the body are known as opioids. They communicate to your brain that you are not in pain [1].

They're used to treat moderate to severe pain that doesn't seem to react to conventional pain relievers.

Opioid medications include:

• Codeine

• Fentanyl (Actiq, Abstral, Duragesic, Fentora); hydrocodone (Hysingla, Zohydro ER); hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin); hydromorphone (Hysingla, Zohydro ER); hydromorphone (Hysingla, Zohydro ER); hydromorphone (Hysingla, Zohydro ER); (Dilaudid, Exalgo)

• Meperidine is a sedative (Demerol)

• Methadone is a narcotic (Dolophine, Methadose)

• Morphine (narcotic) (Kadian, MS Contin, Morphabond)

• Oliceridine is a kind of oliceridine (Olynvik)

• Oxycodone (Oxaydo, OxyContin)

• Oxycodone and acetaminophen (Percocet, Roxicet)

• Oxycodone and naloxone (Oxaydo, OxyContin)

Before you start taking opioids, you'll need a doctor's prescription. To assist control pain, the doctor can adjust the dose as needed [2].

To control pain throughout the day and night, you may be given round-the-clock doses. In the event that you experience "breakthrough" pain despite round-the-clock doses, your doctor may prescribe opioids to be taken "as required."

To control pain throughout the day and night, you may be given round-the-clock doses. In the event that you experience "breakthrough" pain despite round-the-clock doses, your doctor may prescribe opioids to be taken "as required."

• If you have any potential interactions or medical conditions that could make you more likely to have side effects, such as sleep apnea, alcohol use, or kidney problems

• If you have any potential interactions or medical conditions that could make you more likely to have side effects, such as sleep apnea, alcohol use, or kidney problems

• Whether you're taking the medication correctly.

• Always see your doctor before changing or discontinuing any opioid medication. If a pain medicine isn't working as effectively as it should, your doctor may change the dose, add more drugs, or try something new.

• If you're ready to quit using opioids, your doctor may gradually wean you off of them if you've been taking them for a long period. This allows your body to adjust. Otherwise, you may get withdrawal symptoms [3].

Opioid Adverse Effects

Gastrointestinal issues: When you first start using opioids, you may have nausea and vomiting. It usually goes away after a few days. After taking a dose, try lying down for an hour or so, or consult your doctor for an over-the-counter or prescription nausea medication.

Constipation is a typical side effect of opiate use. They cause food to travel more slowly through your system, resulting in harder, more difficult-to-pass stools. If you start to have problems, you should:

If you haven't had a bowel movement in more than two days, you should contact your doctor.

Drink a lot of water. Some persons with minor constipation benefit from this alone. Others, on the other hand, may be required to do more. A hot beverage in the morning can help to move things along in your GI system. Caffeine-containing beverages, such as coffee and tea, should be avoided in favour of hot water with lemon or herbal tea. 

Check to see if there are any other medications that could help. Your doctor may prescribe a stool softener or laxative that you can purchase at the pharmacy. Other medications are only available with a prescription. Lubiprostone (Amitiza), methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol (Movantik) have all been approved by the FDA to treat constipation caused by opioid use in chronic pain patients [4]. 

Opioids can be harmful when combined with alcohol or certain prescriptions, including: 

• Some antidepressants and anxiety medications (especially benzodiazepines like alprazolam, clonazepam, and lorazepam) • Some antibiotics • Benzodiazepines

Tolerance to opioids and addiction

After a while on opioid pain medication, you may notice that you require more and more of the drug to have the same pain-relieving effect. This is referred to as tolerance. It's not the same as addiction, which is defined as the uncontrollable use of a substance.

You can develop dependent on opioid medications if you use them for a long time [5]. This can occur when your body has become so accustomed to the drug that you experience withdrawal symptoms such as

• Diarrhea, nausea, and vomiting

• Anxiety

• Irritability

• Muscle pain

1. Sterken J, Troubleyn J, Gasthuys F, Maes V, Diltoer M, et al. (2004)  Eur J Emerg Med 11: 298-301. 

      

2. Tarabar AF, Nelson LS (2003) Curr Opin Pediatr 15: 210-215.

      

3. McCarberg BH (2011)  J Postgrad Med Inst 123: 119-30.

      

4. Alexander GC, Kruszewski SP, Webster DW (2012) JAMA 308:1865-1866.

      

5.  Franklin GM (2014). Neurology 83:1277-1284.