Patient education: Opioid medicines for short-term treatment of pain (The Basics)

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What are opioid medicines? — Opioids are a group of powerful medicines that relieve pain. They are stronger than pain medicines you can buy without a prescription.

What do doctors prescribe opioids for? — Opioids are used for treating pain in people who have cancer, sickle cell disease, or other long-term conditions. Doctors also prescribe them to relieve severe pain that lasts for a few days, like after an operation. This type of pain is called "short-term" pain. Short-term pain can happen after:

●Surgery

●A major dental procedure

●A serious injury, such as a broken bone or other injury from a car accident

●Some illnesses, such as kidney stones (for people who cannot use other pain relievers like "NSAIDs")

Not everyone needs an opioid medicine in these situations. Your doctor will decide if your pain requires treatment with an opioid.

This article covers what you need to know if you take opioids for short-term relief of severe pain. For short-term pain relief, opioids are often prescribed as "immediate-release" pills. These work quickly.

Opioids also come in other forms that release the medicine into the body slowly over time, such as "extended-release" pills or skin patches. Those types of opioid medicines are used for treating long-term pain and have different instructions and cautions. If you need to take opioid medicines for a longer time, such as for pain caused by cancer, your doctor will talk to you about what you should know.

Are opioid medicines safe? — Opioids are generally safe if you take them only when needed for severe pain, and only for a short time. A short time means a few days or a week. They might help you recover more comfortably from your surgery or injury, and get back to your usual activities.

However, opioids are dangerous if they are not used correctly. If they are misused, for example if you take them when you don't need them for severe pain, there is a risk of getting addicted. Also, if you take too much at once, or take them with alcohol or certain other drugs, opioids can cause serious harm or even death from overdose.

There is more information later in this article on how to use opioid medicines safely. It's important to read the entire handout carefully.

What are common opioid medicines? — For short-term relief of severe pain, many people get a prescription for a low dose of an opioid medicine. Opioid medicines used for this include oxycodone, hydromorphone, hydrocodone-acetaminophen, tramadol, and codeine. These opioids come as "immediate-release" pills, meaning they work fast to relieve pain. They are also available as liquids, suppositories, and shots for people who cannot swallow pills. The table shows different opioids used for short-term pain (table 1). Opioids also come as "extended-release" pills, patches, lozenges, and sprays. Extended-release forms are not used for short-term pain. Those types of opioids are used for treating long-term pain, and are not covered in this article.

Will my doctor prescribe more than 1 pain medicine? — Your doctor will usually prescribe another pain reliever along with the opioid. This might include an "NSAID" such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve), or acetaminophen, which is also known as paracetamol (sample brand name: Tylenol). That way, you can use less opioid pain medicine, and use the opioid only when an NSAID or acetaminophen is not enough to relieve your pain. For example, if you take acetaminophen and ibuprofen 3 or 4 times a day, you might get enough pain relief by taking only 1 opioid pill in the morning and 1 in the evening to help you sleep. And if you keep taking acetaminophen and NSAIDs as your pain gets better, you should be able to stop the opioids first.

It's important to:

●Talk to your doctor or nurse to find out how much NSAID and acetaminophen you should take. People with some medical conditions should not take NSAIDs at all.

●Know that some opioid medicines come combined with acetaminophen or an NSAID in the same pill. If your medicine has both, you should not take any extra NSAIDs or acetaminophen without talking to your doctor first. Make sure you know what is in each of your medicines and when to take them.

Your doctor might also suggest other ways to help reduce pain without medicine, such as ice, heat, rest, or relaxation exercises. In some cases, they might give a shot of medicine, like lidocaine, to numb the part of the body that hurts.

How do opioids work? — Opioids relieve pain by blocking pain signals in the nervous system. They also reduce anxiety and stress caused by pain, and they might help you sleep. Opioids also block other nerve signals in the body, which causes side effects. For example, if you take too much of an opioid, it can cause serious problems like not breathing enough.

What can I do to use opioids safely to treat my pain? — There are things you can do to use an opioid medicine more safely and help protect yourself and others:

●Follow your treatment plan carefully. Take only the amount of medicine your doctor prescribes, and only as often as they tell you to. Different people need different doses. Never take opioids that were not prescribed to you. Talk to your doctor or nurse if you think your opioids are not helping enough with your pain.

●Do not drink alcohol while you are taking opioids

●Do not take opioids with medicines that make you sleepy, or with any other medicines, unless your doctor tells you to

●Do not drive a car, use dangerous machinery, or do other risky activities while taking an opioid medicine. Opioids can make you feel tired or have trouble thinking clearly.

●Store your opioids in a safe place, such as a locked cabinet. This will prevent children, teenagers, or anyone else from getting to them.

●When your pain gets better, get rid of any leftover medicines. Your doctor, nurse, or pharmacist can suggest ways to get rid of them. This might involve flushing them down the toilet, or mixing them with something like dirt or cat litter before putting the mixture in the trash. Some police stations and pharmacies also take leftover medicines.

Try to get all of your pain medicines from the same doctor. If that is not possible, be sure all of your doctors know every medicine you take, even those that are non-prescription. Bring a complete list of all of your pain medicines and other medicines with you whenever you go to a doctor, nurse, dentist, or pharmacist.

Do opioids have side effects? — Yes. Opioids can cause some side effects that are just bothersome, and some that are dangerous.

●Dangerous side effects – If you have taken too much of an opioid medicine or think someone is having a drug overdose, immediately call for an ambulance (in the US and Canada, call 9-1-1) or get the person to the hospital. Do this if a person:

•Can't seem to wake up or seems very drowsy

•Becomes very confused

•Is breathing very slowly or stops breathing

•Passes out or has seizures

•Becomes unable to urinate

Emergency responders can treat an opioid overdose with a reversal drug called "naloxone." This can save the person's life. But it needs to be given as soon as possible.

●Bothersome side effects – Talk to your doctor or nurse if you have side effects that bother you, such as:

•Constipation – Your doctor or nurse might suggest you take a laxative or stool softener to prevent or treat constipation. It's also important to drink plenty of water.

•Mild nausea or stomach discomfort – Taking the medicine with or after food can help with this.

•Nausea, vomiting, or itchiness – If you have any of these problems, your doctor might be able to switch you to a different medicine.

•Dry mouth

•Feeling dizzy or sleepy, or having trouble thinking clearly

•Vision problems

•Being clumsy or falling down

If you suddenly stop taking your opioid after taking it on a regular schedule for several days, you might have unpleasant symptoms called "withdrawal." This can include a stomach ache, diarrhea, or shakes. If you have been taking opioids regularly for several days or longer, ask your doctor if you need to reduce your dose gradually.

Are opioids addicting? — In some cases, taking opioids can lead to opioid misuse or addiction:

●"Opioid misuse" (or "abuse") means taking an opioid in a way that is different than your doctor directed

●"Opioid use disorder" is the medical term for opioid addiction. This is when a person can't control their use of the opioid. A person who is addicted to opioids might use more than they planned to. They might need higher doses to get the same effect they used to get with fewer pills or a lower dose. Or they might want to stop or use opioids less often, but not be able to.

The risk of these issues is higher for people who have problems with drug or alcohol use. It's rare to get addicted to opioids if you are taking them short-term for severe pain only when you need them and following all of your doctor's instructions.

If you have a history of substance misuse or substance use disorder, it's best to avoid opioids completely if possible. Your doctor can help you find ways to treat your pain without an opioid. Or they might suggest seeing a doctor who is a pain specialist.

What if I am pregnant? — There are risks to taking opioids during pregnancy, especially if it is for more than a few days. Talk with your doctor about ways of treating severe pain that will be best for you and your baby.

How can I learn more about my medicine? — For more detailed information about your medicines, ask your doctor or nurse for the patient handout from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.