PAINKILLERS may be making agonising pain worse, experts have warned.
Rather than giving fibromyalgia sufferers relief, opioid painkillers actually seem to be making chronic conditions worse – with doses having to be regularly increased.
Currently, around 8 million people in the UK live with pain that goes on for longer than three months.
And to treat that, GPs have been prescribing millions of opioid painkillers.
According to a BBC investigation, GPs prescribed a terrifying 23.8 million opioid painkillers to people across the UK in 2017. That’s 10 million more than in 2007.
Nearly half of these patients were prescribed opioids in bulk.
Four out of ten patients with chronic musculoskeletal pain, for instance, take three or more opioids simultaneously, typically codeine plus tramadol and morphine, according to a 2018 study in the journal BMJ Open.
In the USA, concerns over an “opioid epidemic” have been growing.
During 2017, nearly 50,000 opioid overdose deaths were recorded in the states. Today, two million Americans are addicted to opioids and there are around 115 deaths a day from misuse.
Now, a leading expert is warning that the UK could face a similar crisis.
Professor Jane Ballantyne, a pain management expert, has told The Mail about the “open-ended dose escalation”, where doctors increase the dose of powerful painkillers to match patients’ resistance.
When you take painkillers – and opioid painkillers in particular – over a period of time, your body builds a resistance to their effects.
That means that you might still feel a certain degree of pain even after taking painkillers that once got rid of it.
The number of opioid prescriptions dispensed by doctors steadily increased from 112 million prescriptions in 1992 to a peak of 282 million in 2012, according to the market research firm IMS Health.
Opioids can be incredibly addictive. They work by disrupting pain signals in the brain and spinal cord and releasing the hormone dopamine, which then creates a “high”.
Drugs like morphine and codeine are basically made from the same process as heroin (from opium poppy plants), while hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients.
“The UK system, with GPs as gatekeepers of healthcare, should protect against overuse of opioids in a way that isn’t true of the U.S., where widespread advertising to patients raises awareness of opioids, and people can go from one doctor to another to get extra supplies,” Prof Ballantyne.
“Despite these safeguards, I hear from colleagues in the UK that the NHS could now be facing the same kind of problems.”
But Dr Sarah Jarvis doesn’t necessarily agree.
“We do have a huge problem, but it’s on the same scale as America’s,” Dr Sarah Jarvistold The Sun.
“The reason that we are not working with exactly the same problem as the US is the NHS.
“Under the NHS, we are moving towards recommending ‘whole person’ approaches to pain, rather than just looking at tablets because we are aware of the potential problem that pain killers can cause.”
Years ago, Dr Jarvis says, doctors thought that opioids weren’t addictive and so were more inclined to prescribe them.
However, we’ve long been aware that that’s not the case – and that can be challenging when patients turn up in severe pain asking for immediate relief.
In recent years, there’s been a move to increasing the number of pain clinics in the UK.
These are multidisciplinary clinics which have teams of psychologists and physiotherapists working alongside anaesthetists to help patients deal with – rather than cure – pain.
“We also have a lot of pain management groups which look at the psychological impact of pain and the physical side of things,” Dr Jarvis explains.
“They too will help patients – they can’t relieve the pain but help to cope with it.
“With all painkillers, with opiates, your body adapts after a certain length of time so you need more and more to get the same effect. It’s the same with alcohol. Your body will change and you need higher and higher doses to feel the same level of relaxation or ‘high’.”
While doctors in the UK always recommend the lowest dose for the shortest possible time (or so the theory goes), Dr Jarvis explains that over in the states, healthcare is dependent on someone’s level of insurance.
Often it’s more affordable to be prescribed painkillers rather than having doctors send patients out to these alternative, more holistic pain management centres that often aren’t covered by medical insurance.
So what’s the solution?
Well, it might be worth actually asking for help with dealing with pain rather than demanding immediate relief from your GP.
“GPs have to stick to a ten-minute appointment, and when you’re faced with someone with long-standing pain, there’s pressure to pick up your prescription pad and step up pain relief, “Dr Campbell Murdoch, a GP in Yeovil, Somerset, and Quality Improvement Clinical Advisor for NHS England, told The Mail.
Chronic pain is a lifestyle issue and not a medical one, Prof Ballantyne concluded.
“We know that acupuncture, yoga, tai chi and walking can relieve chronic pain by boosting the body’s natural opioid system. It’s a lesson we need to learn, though it might take generations to be widely accepted.”
It’s about giving people better coping strategies for dealing with long-term pain, and working out what lifestyle modifications might reduce it slightly.