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  • Rachel Johns

Pain Killers or Pain Enhancers ?

Have you experienced pain that lasts a very long time and never seems to get better despite taking medication for it? Maybe your pain has even worsened over time and you’ve had to increase your dosage?

Current research on the effects of prolonged exposure to medication for chronic pain now highlights many issues around why taking prescribed opioid drugs is likely to be making your pain worse.

Opioids’ are depressant medications which slow down the activity of the central nervous system (CNS) and messages going between the brain and body. They are commonly prescribed to treat pain, with their immediate effects being analgesia (pain relief) and euphoria (a feeling of well being). Morphine and Codeine are two common examples of opioid drugs.

There is now growing evidence that taking opioids for greater than 3 months to manage symptoms of pain is directly linked to ‘Central Nervous System Sensitisation.’ This is the development and maintenance of chronic pain caused by a ‘wind-up’ of the nervous system where it remains in a persistent state of high reactivity. In more simple terms, this means that our nervous system becomes MORE sensitive to pain rather than less sensitive after taking opioids.

As Physiotherapists, we often see patients who have been taking opioid medications for very long periods of time. They often present with:

  • A long history of pain that keeps getting worse and symptoms of very minor or non-existent musculoskeletal issues.

  • They often undergo multiple investigations and interventions – such as scans, injections and surgeries – with no improvement in their symptoms.

  • Have been taking opioid drugs for more than 3 months and have to continually increase their dose to manage symptoms.

  • Widespread sensitisation and diffuse pain with very little mechanical pattern or provocation.

With time and research we are becoming more aware of the effect opioid use has on pain, especially long-term use and higher doses. Our pain threshold is lowered so we actually experience more pain than usual, and the pain doesn’t go away despite the fact our injury in completely healed. We also build up a tolerance to opioid medications and have to increase the dose to get the same relief.

Along with causing our nervous system to become extremely hypersensitive, opioids have a negative effect on our cognitive function, mood, concentration, memory and driving ability. The rates of depression are also higher in patients who have long-term exposure to opioids when suffering from chronic pain.

So what can we do?

Reduce Medications – Weaning off opioids has shown to reduce pain with less side-effects on overall health and wellbeing. Talk to your Doctor about how to safely and gradually reduce your dose over time and avoid symptoms of withdrawal.

Exercise – Regular movement and physical activity is directly linked to reducing symptoms of chronic pain. Exercise calms down the central nervous system and improves our tolerance to painful stimuli. It also relieves musculoskeletal tension by improving muscle strength and flexibility. Always choose an activity you enjoy and try to be active at some stage every day. Your Physiotherapist is the best person to help you start exercising.

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