Opioids are commonly used to treat chronic pain experienced by cancer patients, and in many cases, it is now being prescribed for chronic pain in non-cancer patients as well. However, due to the many issue related to their use they have remained a controversial topic in the healthcare industry. It is important for any health care professional to know about the various issues associated with opioids in order to better manage them in their patients.
Side effects of opioid pain medication and their management
A lot of the patients who receive opioids as treatment experience certain side effects. The most common of these is constipation, but others include:
- Respiratory depression
- Sedation
- Urinary hesitancy or retention
- Dry mouth
- Nausea/vomiting
- Itching
- Sweating
- Hypogonadism
- Myoclonus
While certain side effects such as sedation may decrease over time, other such as constipation remain a major issue throughout treatment. Constipation is so common in patients being treated with opioids that it is more of a red flag for clinicians when the patient does not present with this. To counter this, laxatives are prescribed at the time the treatment is initiated. Other side effects may be controlled by switching the kind of opioids being administered.
Opioid pain medication and pregnancy
Opioid use during pregnancy may be correlated with adverse outcomes in newborns, some studies suggest. These can include low birth weight and premature birth. However, causality is not certain as other correlated maternal factors may also play a role in this. It is important to note that withdrawal may be experience in newborns of opioid dependent mothers.
Driving and work safety
When opioid therapy is initiated, sleepiness, clouded thinking, decreased concentration, slower reflexes, or in-coordination is very common, and this may impair driving abilities posing a danger to both the patient and others on the road. However, studies have failed to show a correlation between opioid use and impaired driving or vehicle accidents. Plus, with continued and consistent use, some of the cognitive and motor impairment can be overcome. Clinicians should practice their best judgment when allowing patients to continue driving.
The APS-AAPM suggests that patients starting out on opioid treatment should refrain from driving or engaging in dangerous work activities. Especially patients with vocations such as school bus drivers and pilots should be restricted.
Long-term use and the endocrine system
Patients on long-term opioid treatment are at increased risk for developing hypogonadism which is why it is important for them to get a screening of the endocrine system prior to beginning treatment and then get annual tests done as long as treatment continues. Symptoms of hypogonadism include fatigue, mood changes, decreased libido, loss of muscle mass, and osteoporosis, and testing is crucial for patients who present with these symptoms.
Managing drug abuse in patients
Certain patients can begin to exhibit aberrant drug-related patterns and these patients should be closely watched. If clinicians suspect certain patients are abusing the drug, thorough investigations must be carries out and the patient-practitioner relationship should be re-evaluated. The way a medical practitioner deals and interacts with the patient goes a long way in influencing the treatment outcomes.
The situation must be thoroughly investigated before the clinician makes any accusations. There may be other reasons why non-adherence occurs, such as failure to relieve pain or inability to understand the terms of the patient-practitioner agreement or the prescription. If the problem seems to be out of the hands of the clinician, the patient must be referred to an addiction specialist or a psychiatrist.
Conclusion
It is the duty of a healthcare professional to closely monitor treatments for such controversial drugs as opioids, as their primary concern is the well-being of the patient and that may be at risk if such drugs are not administered carefully. Your patient should be educated about the potential side-effects of the drug and should be regularly monitored and screened for possible harmful effects to make sure their treatment goes smoothly.
