Opioids - A War Within A War - Part Four

Opioid Side-Effects & Risks

This post, "Opioid Side-Effects & Risks," is the fourth installment in my series "Opioids - A War Within a War," It examines a crucial topic for anyone who takes or is planning on taking opioids for chronic pain. Next week's posts will include "Opioids, Insurance, and Costs," the fifth installment, followed by the sixth and final installment, "Opioids & Your Doctor." These six installments will give you a comprehensive understanding of chronic pain and opioids from a patient's perspective, which should serve you well if you are considering opioid therapy to treat your chronic pain. 

Opioid Side Effects & Risks

There are many side effects and associated risks of taking opioids that can affect you physically, mentally, emotionally, and in other ways. Among them are:

PHYSICAL

• Constipation: This is a significant side effect that you must plan for and proactively treat to keep it at bay and stay regular. I’ve found that while they work, laxatives can be challenging to regulate on a long-term basis. Instead, stirring polyethylene glycol (MiraLAX) in a glass of juice each night, makes managing constipation comfortable and effective. The most important things are (1) Find the exact dosage that works for you that balances between too much and too little results (two heaping tablespoons to start with should work), and (2) Take it religiously at the same time every day (one hour before bed when taking nighttime medications for example). I have been following this regimen for ten years now, and this common side effect of opioids is not a problem for me. It’s safe, effective, and easy, which as a bonus, means that there is one less pill for me to remember to take each day!

• Dizziness & Balance: These issues can be quite problematic when you first begin taking opioids for pain. However, your body gets used to it over time. Eventually, it will become a minor side effect unless your doctor increases your dosage substantially or moves you to a new class of opioids. While you’ll probably have some balance issues over time, for me, they are rare. Of course, everybody processes these drugs differently, so you might have more or fewer issues depending on your physiology and the other medicines you are taking. A best practice, I think, is to assume that you will have these issues and act accordingly.

MENTAL

• Memory Loss: Over time, memory loss is something we all have to deal with due to aging, and taking opioids only exacerbates this issue. I don’t know of any way around it other than trying to stay aware of it and take excellent notes! (Now, if I can just remember where I put my notes!)

• Brain Fog: Like memory loss, some brain fog just comes with the territory when you take opioids. This is similar to what’s known as “chemo brain” to cancer patients taking chemotherapy. My wife constantly complained about her chemo brain due to her numerous chemotherapy sessions while treating her two bouts with cancer. I could see it as she struggled to remember things or had problems getting her words in the correct order in a sentence. One of the best solutions for brain fog is to exercise regularly to help get plenty of oxygen to your brain! But on the whole, brain fog for long-term patients like me is a very minor issue, if at all.

EMOTIONAL

• Anxiety and Fear: These are common side effects of opioids, and your emotions can take a real beating from the constant roller coaster you feel like you are riding up one minute and down the next! Unfortunately, this side effect is not something pain doctors typically treat. You may need to get professional counseling from a psychologist, psychiatrist, or social worker to help you work through these issues. Perhaps the most significant emotional toll for opioid patients is the anxiety caused by the fear of running out of your medication. It is very easy to become anxious about any changes in your prescription, losing your meds, or not having enough to treat your pain adequately. I believe that these emotions increase your pain, so it is vitally important to share these feelings with your pain doctor so they can help put your mind at ease.