Pain Medications Can Become Too Much of a Good Thing

by Emily Mullen, MD, FACP, Mid Carolina Internal Medicine

Pain medications are a common go-to solution for everything from headaches to injuries to chronic conditions. While these drugs provide much-needed relief, some come with potential risks that many people overlook.

There are a wide variety of medications used to treat pain. Some are available over the counter, like acetaminophen or ibuprofen. Others require a prescription, including drugs like gabapentin, muscle relaxers and opioid pain medications. Opioid medications include morphine, tramadol and oxycodone, to name a few. 

Developing Tolerance or Dependence
Dependence on medication means that if you stop taking the medication abruptly, you can develop withdrawal. Tolerance means you need more of the medication to get the same benefit. Tolerance and dependence can develop quickly, sometimes as soon as three days after beginning to take an opioid medication. It may be safe to take these medications for up to two weeks without developing dependence, but individuals need to discuss this with their primary care doctor. 

Some people have a higher risk for having a problem with these pain medications. Risk factors for becoming dependent on opioid pain medications include:

• Using a medication differently than prescribed, such as crushing or injecting the medication or taking more than prescribed
• Being younger
• Having a personal or family history of substance use
• Increased stress in living situation
• History of a serious mental health diagnosis
• Use of tobacco products
• Having chronic conditions and taking opioids for an extended amount of time

How Long Should You Take Pain Medication?
I recommend patients with an acute injury take opioid pain medication for no more than three days. They should also be utilizing other strategies, including heat, ice, and over-the-counter drugs, to decrease the need for opioid medication. 

For those recovering from surgery, the recommendation is no more than 5-7 days of opioid pain medication. 

For people suffering from chronic pain, that answer is more complicated.  My recommendation for patients who require opioids to manage chronic pain is to do so under the care of a physician who can monitor and work with them to find the best strategy to decrease the pain to tolerable levels. 

Alternatives to Opiates
There are other medications that can help with pain. As mentioned, acetaminophen, ibuprofen and naproxen can help with pain (ensure it is safe for you to take and take as described on the bottle). Other classes of non-opiate medications can also help with pain management. 

For those with a substance use history who also have cravings, buprenorphine products can help manage the substance use and the pain that they are experiencing. Buprenorphine products may also be appropriate for those with chronic pain who never develop substance misuse. 

Patients need to speak with their healthcare provider honestly about their pain, including what they have tried in the past and if they have used anything in a way other than prescribed. Using this information, their physician will help develop a better plan to control their pain so they can be active and well. Sometimes, providers may want patients to see a pain management specialist and will refer patients when appropriate.  

Emily Mullen, MD, FACP, Mid Carolina Internal Medicine