(ĐTĐ) – Most medications have a maximum dose. Usually, the maximum dose is one that you cannot exceed without suffering harm. In the case of most pain medications, taking more than the maximum dose will not increase the pain relief but may cause toxic side effects such as stomach ulcers, kidney damage, liver damage, chemical imbalance in the bloodstream, or death.
Strong opioid medications are slightly different in this regard, and this is fortunate for people who suffer from severe pain. With strong opioids, the dose depends on the amount of pain. These medications should not mixed with acetaminophen or other non-opioid drugs when used to treat chronic pain. People with intense pain can take very high doses of opioids without getting side effects. Some people with intense pain get such high doses that the same dose would be fatal if taken by someone who was not suffering from pain. In the pain patient, that same high dose can control the pain and still allow the person to be wide awake enough to do his or her activities of daily living.
Long-acting opioid: The best way to treat chronic, severe pain is by keeping it under control all the time. Your doctor can do this by using a long-acting opioid to keep the pain under control and a short-acting opioid to deal with those few times during the day when the pain breaks through. So, if you are on morphine, you would get a slow-release tablet that would keep your pain under control most of the time, and a short-acting tablet or liquid for those times when your pain breaks through.
Bad opioids: Some opioids are not recommended for chronic pain.
Demerol (meperidine), which is used often for acute pain after surgery, is a poor drug for chronic pain. It is not absorbed well when taken by mouth, and it causes dysphoria (feeling truly lousy) and seizures if used for more than a few days.
Talwin (pentazocine) is also bad for chronic pain. It has a ceiling effect. There is a maximum dose after which raising the dose gives no further pain relief. It also causes withdrawal symptoms when given to someone who is also taking another opioid.
The opioid/acetaminophen or opioid/NSAID combination drugs are fine for short-term use, but acetaminophen is poisonous to the kidneys and liver when used for a long time or in high doses. Many NSAIDs are toxic to the kidneys and stomach when taken for a long time or in high doses.
Complications of opioids
Nausea and vomiting: These are common side effects at the beginning of opioid therapy. If they are a problem, they can be controlled with nonprescription medication for nausea such as Bonine, Dramamine, or Benadryl, or, in some cases, by prescription medication such as prochlorperazine (Compazine) or haloperidol (Haldol). The nausea and vomiting usually stop within a few days, and then the antiemetic (antinausea and vomiting) medication can be stopped.
Dizziness: Dizziness and sleepiness are common when you take opioids. That is why it is recommended that you not drive, drink alcohol, or operate machinery while taking opioids. People who have chronic pain often develop tolerance for this side effect of opioids and often can do all the normal activities of daily living while on opioid therapy.
Constipation: Opioids always cause this problem, and constipation continues to be a problem for as long as you take opioids. Constipation can become a serious problem if you do not keep it under control. The stool can become totally blocked off (fecal impaction). This is treated by a very uncomfortable procedure in which the treating doctor or nurse puts a gloved finger up your rectum and pulls out pieces of feces until the problem is cleared. You can appreciate how you would much rather prevent this problem than have it treated. Use Senna and Docusate. Both are available without a prescription. Take enough of them to make sure the bowels move every day, however much that takes.
Addiction: Hospice patients worry about becoming addicted to opioids. With hospice, however, it is rarely an issue. People with chronic pain also worry about addiction, but it turns out that for most adults, if they do not already have a substance (alcohol or drug) abuse problem, addiction is not much of an issue even when opioids are used on a long-term basis.
A study was done in which 12,000 nonaddicted people who needed opioids were followed up to see if they had become addicted. Four out of 12,000 showed addictive behavior (less than one tenth of 1%).
Generally, the only people who develop addictive behavior after being given opioids had an addiction problem before the opioids were given for pain. Most people take opioids until the pain goes away. Then they stop taking them because they do not want to feel dizzy or drowsy. Once the pain goes away, the toxic side effects of dizziness and drowsiness come back.
Anyone who takes any medication just to “get high” is already showing addictive behavior and needs to stop taking addictive substances, including opioids, other addictive drugs, and alcohol, immediately.
Some people with actual painful illnesses are addicted to mind-altering substances. They get prescriptions because of their actual illnesses. Here’s how the patient or the family can tell the difference between someone who needs opioids for pain and someone who is abusing opioids. Normally, the dose of opioids is arrived at by the patient telling the doctor how they are doing with the pain and by participating in their activities of daily living. A chronic pain patient who is not addicted to medication will tell the doctor the truth about his or her ability to function and do what needs to be done in daily life.
Addicts will lie about performing activities of daily living. The addict will claim that the pain is so severe that they need a higher dose until they get to a dose that causes them to be asleep most of the time. Then, they will tell the doctor that they are doing fine and are able to do all the activities that they need to do.
Selling the medicine to others is a federal crime that could get the seller a very long jail sentence and could lead to government seizure of your car or your house.
Family members must let the doctor know what is actually happening in this sort of situation. When an addicted person actually has a painful syndrome, the doctor, with the help of the family, may have to decide what the dose of medication should be, without reference to the dose the pain patient thinks would be best. Sometimes, in severely addicted people, the opioids should not be used at all. Some addicted people can be treated with opioids if necessary as long as they cooperate carefully with the treatment plan.
Respiratory depression: The most dangerous complication of opioid therapy is respiratory depression. Everyone knows that some drug addicts have been known to get pure heroin or fentanyl and then die with the needle still in their arm because they fell asleep and didn’t breathe. That happens because of a huge overdose in a person who is not in pain. Pain is a potent stimulator of the respiratory center in the brain. So if you have pain, and your doctor increases the dose of opioids carefully until the pain is controlled, and then stops raising the dosage, you will not get respiratory depression.
Fortunately for people with pain, large doses of opioids can safely be used if they are necessary to combat severe chronic pain.