Opioids are a group of medicines that have similar effects to morphine. Medicines in this group include buprenorphine, codeine, dihydrocodeine, fentanyl, oxycodone, tapentadol and tramadol. They are particularly useful for pain after surgery or trauma, and may help conditions such as arthritis, nerve pain and back pain, for up to three months. However, opioid medicines are much less effective over lengthy
periods. They can sometimes lead to an increase in pain and many other harmful side effects.
Gabapentanoids Such as gabapentin and pregabalin are medicines that can treat nerve pain, diabetic neuropathy, (nerve pain in the feet), generalised anxiety and restless leg syndrome.
Benefits of opioids and gabapentanoids
Both opioids and gabapentanoids can only help to relieve pain, if successful then pain can be reduced by around 20-30%, it is unlikely that they will take the pain away completely. It is hoped that if you experience some pain relief you will be able to be more active and improve your quality of life, increasing your daily activity with gentle stretching, short walks, or activities you enjoy.
However, opioids and gabapentanoids have a limited effect and for some will not give any substantial benefit. If they are not helpful after a few weeks, further increases to the dose may not be appropriate.
Side effects and harms
Common side effects of opioid medicines include constipation, fatigue, drowsiness, dizziness, nausea, poor concentration, depression, increased anxiety, sweating, itching, changes to the normal breathing pattern, hormone changes that can lead to a low sex drive, reduced bone density and infertility. Life expectancy can also be lower for a person taking high doses of opioids for a long time. Gabapentanoids can often cause dizziness, fatigue, confusion, headache, drowsiness, tremors, sexual dysfunction, weight gain and abnormal appetite. Tolerance to these medications will develop over time, meaning they are less effective, and you may become addicted or dependant on them. Taking combinations
of these medicines in high doses is likely to increase the side effects you could experience and can cause severe drowsiness and breathing problems.
Taking opioids and gabapentinoids for prolonged periods of time can also increase your pain and reduce your ability to function and carry out your daily activities and can become increasingly harmful to your general health. Some people may feel they do not have any noticeable side effects; however, they will still be at risk of the harmful effects the liver, kidneys, endocrine system (hormones), bones and joints and respiratory system.
Alternative options
Managing long-term pain is best if you learn other ways to manage it, such as stretching and exercise, relaxation and pacing activity e.g., breaking activity down to make it more manageable, meditation and mindfulness are also recommended. There are other alternative medicines to opioids and gabapentanoids that may help a small number of people. This should be discussed with your doctor or nurse.
Next steps
• Do you still have pain despite using opioid medicines regularly?
• Do your medicines cause side-effects that affect your daily activities e.g., drowsiness that stops you driving
• Have you noticed a change in your sex drive or sexual function?
• Do you take your medicine because it helps you to relax or make you sleepy? If you answer ‘yes’ to any of these questions, it is likely that the
opioid/gabapentanoid medicines are not suitable for you. If you would like to discuss your medicines and the alternatives options suitable for
you, you can contact the pain clinic or your GP for further support and advice
Useful resources
Understanding and living with long term pain.
www.Livewellwithpain.co.uk
www.britishpainsociety.org
www.knowpain.co.uk
www.retrainpain.org
www.picsnhs.org.uk/pain-pathway
ACT, mindfulness, and others
www.wildmind.org (Site has a programme of online mindfulness instructions)
www.workingwithact.com
www.actionforhappiness.org
PICS (Primary Integrated Community Services) 0300 830 000-option 1
Insight (free talking therapies) 0300 555 5582
Further Information and reading
Overcoming Chronic pain: A self help guide using cognitive behavioural techniques, Frances Cole et al.