Arthritis and Opiods

Q:  If I can't tolerate the side effects of anti-inflammatories, are opioids a possible alternative for treating my arthritis?

A:  Opioids are often overlooked as effective drugs for treating the pain of arthritis. While doctors are typically cautious, if not averse, to giving opioids such as morphine for any extended period of time, I have found a different reaction from many rheumatologists (the medical specialists that are most expert at treating arthritis).


Rheumatologists are acutely aware that taking nonsteroidal anti-inflammatory drugs (NSAIDs) and other anti-inflammatory drugs for a long time can produce serious, even lethal, complications. In light of these problems, many rheumatologists are reluctantly becoming more willing to prescribe narcotics.

They often tell me that although narcotics are widely perceived as more dangerous than anti-inflammatories, the opposite may be the case. While many doctors worry about the repercussions of long-term use of morphine-type drugs, many rheumatologists view them as less risky than long-term daily doses of many over-the-counter pain relievers.

Nevertheless, while opioids can offer substantial relief with, in many cases, less severe long-term side effects than chronic anti-inflammatories, they are not widely recommended for patients with chronic pain from arthritis. I think the reason for this is fear and concern about social stigma on the part of patients and doctors based on outdated ideas about addiction. Even though pain medicine is introducing new ideas and methods that are changing the way people think about many medications, a cloud continues to hang over the medicinal use of narcotics.

Doctors are not the only people reluctant to venture into using opioids. Patients also have been led to believe that all narcotics are addictive and if they need or want their pills too much, they are just one step away from becoming a junkie. Some patients are so worried about getting hooked on their drugs that they may downplay their pain and say they do not need opioids, take only part of the prescribed dose, or stop taking their mediation altogether.

There are sensible ways to prescribe opioids for chronic pain that minimize the chance of addiction and increase the chance that addiction will be noticed if it occurs. For starters, the sustained release opioids that I use for chronic pain are less likely to produce the euphoria that is often a basic feature of narcotic abuse.

Opioids for chronic pain are time-release or long-acting drugs that are taken in pill or patch form (not injected) so they slip into the bloodstream gradually, without large peaks and valleys. Therefore, the same rush or high that comes when short-acting drugs speed to the brain does not happen.

When a person receives pain relief medicine in steady doses, the pain is not completely abolished but diminished enough so they can return to normal activities. Instead of euphoria or addiction, pain slides from unbearable to bearable, freeing an individual to rejoin their family, return to work, do favorite activities, and enjoy being alive.

All pain relievers for chronic pain (including opioids), are intended to mute pain enough to help a person function better; they usually do not eliminate it altogether.

Scott Fishman, M.D., is a leading expert in pain management.


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