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Why opioids make pain worse

The 5 reasons painkillers won’t give you lasting relief from chronic pain – and what actually will.

Pain is common and we all experience it. It’s your body’s way of telling you that something is wrong when you break a leg, cut your finger or have another injury.

Chronic pain is different. Your body hurts even when there is no obvious injury. And it lasts for months, sometimes years. It’s not all in your mind. You really do feel pain. But the fix is not in a pill. Here’s why:

  • Over time, prescription painkillers cause the pain you feel to increase (and they’ll also hurt your body’s ability to reduce pain on its own).
    In the United States we’ve been taught to think that when we feel pain, a pill will make us feel better. That’s true after you have surgery or an injury that will heal in a few days or weeks. But what many people don’t know is that if you use opioid pills for 4 or more weeks, it makes you more sensitive to pain and that makes the pain worse.

    Opioids do provide relief by blocking pain. But then, your body reacts by increasing the number of receptors to try to get the pain signal through again. So when the drug wears off, a person will experience more pain for about three days. If they continue to take opioids, the pills become less and less effective. The pain keeps increasing not because of an injury, but due to the opioids themselves.
    In addition, our bodies have natural opioids called endorphins. If your body becomes used to opioid pain medication, its ability to create and use natural endorphins will decrease. This makes you lose the ability to reduce pain on your own.

  • Opioids can mask emotional pain and trauma.
    Pain is often a mixture of physical pain, emotional pain and suffering. Emotional pain affects the same area of the brain as physical pain, and it can be very hard for the brain to separate them. Each of these parts, however, requires appropriate treatment and care to maximize healing.
    The problem with opioids is that when they are used, they can cover up emotional pain and trauma. And if someone begins to cut back on their opioid use, it often amplifies their pain and suffering.
    Sometimes the traumatic experience that’s triggering pain happened a long time ago. Trauma can put your nervous system in a state of constant heightened alert. If you feel constantly under attack, this response stays turned on even when you are not aware of it. The result is increased pain, anxiety and sleep problems. So in treatment, it’s also important to include psychotherapy that will address this root cause of pain.
  • Painkillers don’t build our resilience – which is key to feeling better.
    For years we wondered why some people become disabled after an injury and some don’t. The answer is that some people are more resilient than others.
    Resilience is the ability to endure difficult experiences and adapt to challenges. And one of the best predictors of recovery is to be higher up on the “mood elevator.”

    We all have a mood elevator. When we take the elevator to higher floors, we experience attitudes and feelings such as being curious, energetic and grateful. When we spend time on lower levels, we are worried and irritated. Taking opiates for a short time can help create a state of well-being. However, using them for extended periods of time often increases anxiety.
    The first step in moving up the mood elevator is to recognize when you are tense and learn healthy ways to relax. This releases chemicals in our bodies that make us feel good, protect us from sickness and help our tissues rebuild.

  • Your pain might stem from an undiagnosed sleep problem – and opioids won’t cure that. In fact, they can make sleep problems worse.
    Poor sleep is associated with many health problems. People who sleep less than 6 hours per night are more likely to be overweight. They’re also at greater risk for heart disease, depression and other problems.
    Among people who have chronic pain, more than half experience problems with sleep. Pain can make it hard to get enough good sleep. And on the flip side, not getting enough sleep can make you more sensitive to pain. If someone uses opiates for more than a few weeks, it can reduce the kind of sleep that restores your body. So it’s important to get an assessment and treat any sleep problems.
  • Motion is the best lotion for your body
    Many people stop moving in response to pain. But they need to know that the best medicine is to keep moving. Daily stretching and movement increases your body’s natural fluids that lubricate your joints.
    Physical therapy can show you how to improve strength and flexibility. And while complementary medicine such as aromatherapy or yoga are not cures, they can help you relax. That will reduce pain and is good for your overall health.

By Alfred Clavel Jr., MD – specializes in pain medicine at HealthPartners RiverWay Pain Clinic

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