The last decade, from 2000 to 2010, was referred to as the “Decade of Pain” in the medical field. Pain was considered the fifth vital sign—a measure of health as important as heart rate, blood pressure, respiratory rate and temperature. There was a big push to prescribe pain medications to patients. And prescriptions for opioid pain relievers skyrocketed. Opioids, also known as narcotics, have been around for thousands of years. Originally they were compounds derived from the opium poppy. Now, of course, there is a wide range of naturally occurring and synthetic opioids available, all manufactured using modern methods. How Opioids Provide Essential Pain Treatment In general, opioids are used to treat moderate to severe pain when non-narcotic medications and more conservative alternatives have failed. When prescribed appropriately and taken as directed, opioids can bring great benefit and relief to patients. Injuries, surgery or dental procedures that cause acute pain are some of the most common indications for opioids. Uncontrolled pain, like that experienced after injury or surgery, can lead to serious complications and prevent healing. Uncontrolled pain can also cause persistent production of stress hormones and adrenaline, leading to increased heart rate, blood pressure and risk of cardiovascular events such as heart attack. Opioids, therefore, play an important role in recovery after injury or surgery. They are also valuable in treating certain severe, chronic degenerative conditions in order to improve function and quality of life. And they are the mainstay of treatment for cancer-related pain. The Risks and Side Effects of Opioids Use of opioids for chronic non-cancer related pain, however, is more complex and controversial now that the “Decade of Pain” has come to a close. Recent evidence has demonstrated that longer durations of treatment and higher doses of opioids are associated with increased rates of falls, fractures, motor vehicle accidents, physical and psychological dependence, medication overdose and death. On top of those risks, opioids come with a variety of side effects that some patients find intolerable. Opioids can cause several side effects involving the central nervous system, including drowsiness, dizziness, mental cloudiness and nausea. There’s also the risk of developing slow, shallow breathing that can lead to severe respiratory depression and possibly damage the heart or brain; this has the potential to cause death. Opioids also have an effect on the gastrointestinal (GI) tract because of the way they relieve pain. Opioids block receptors all over the body from sending pain signals to the brain; however, blocking these receptors in the gut impairs the function of the entire GI tract. While constipation is perhaps the most common GI complaint related to opioid use, other side effects include bloating, abdominal discomfort, gastroesophageal reflux, loss of appetite, nausea and vomiting. The GI effects of opioids may at times be so severe that patients prefer to stop the medication rather than suffer from the consequences. What Patients Taking Opioids Can Do Although the nervous system side effects of opioids, such as drowsiness and nausea, usually improve over time, opioid-induced constipation (OIC) persists throughout the treatment period. In fact, many physicians recommend patients begin a preventive bowel regimen when starting to take opioids. Patients should increase the amount of fluids they’re drinking, add more fiber into their diets, and try stool softeners and laxatives to decrease the likelihood or severity of OIC. If those methods don’t work, patients can try newly available prescription medications that counter the constipating effects of opioids on the GI tract, like methylnaltrexone (Relistor) and naloxegol (Movantik). Recent evidence has highlighted a number of other serious risks associated with long-term use of opioids. These include the risk of developing opioid use disorder (OUD) or addiction to prescribed opioids, along with the risk of overdose, which can, in some cases, lead to permanent brain injury or death. These risks increase dramatically with escalating doses of the narcotics and as the duration of treatment increases. Taking opioids is a big responsibility for both the patient as well as the provider. Before committing to chronic opioid therapy, you should have a thorough discussion with your doctor about the benefits, risks, and alternatives as well as the responsibilities involved with taking these drugs. And if you’re experiencing side effects, tell your doctor. There are many different ways to reduce side effects while continuing to treat pain.