Tips for Talking With Your Doctor About Prescription Painkillers

Prior to the 1990s, opioid painkillers were usually reserved for treating acute pain from surgery, major injuries or terminal illness. But over the past two decades, the powerful pills have emerged as the go-to pain remedy for everything from minor dental procedures to backaches to chronic headaches.

In 2015, doctors doled out enough prescription pain pills to medicate every American around the clock for 21 days straight.

As the use of prescription painkillers have skyrocketed, so have rates of opioid abuse and addiction. And overprescribing is recognized as a key cause of the ongoing opioid epidemic, which has claimed more than a quarter of a million lives since 1999.

Prescription opioids include drugs such as oxycodone (Percocet), hydrocodone (Vicodin), morphine and codeine. The potent medications work by blocking pain signals to the brain. But the drugs also have euphoric and calming effects that make them extremely addictive.

Doctors sometimes fail to mention the potential perils of prescription painkillers. They may even prescribe them when over-the-counter medications or natural remedies might work just as well, if not better.

Asking the Right Questions

Fortunately, there are steps you can take to minimize the risks associated with opioids.

Before filling your prescription, let your doctor know you’d like to discuss your diagnosis and treatment in more detail.

To get the most out of your chat, write down and ask the following questions:

• Why do I need an opioid?
• Are there better or safer alternatives?
• What are the benefits and risks of taking this medication?
• What are the drug’s side effects?
• How will this interact with other drugs I am taking?
• How long should I take this drug?
• Do I need a prescription for naloxone?

Starting this conversation may be difficult or even make you uncomfortable. Doctors are busy people, and patients often feel rushed. Many people also fear that questioning a doctor may be perceived as challenging the doctor’s authority or expertise. This in conjunction with the natural anxiety we all feel when facing health concerns causes people to clam up just when they need answers the most.

As with all aspects of your health, you must be your own advocate when it comes to pain management. You have the right to ask for the information necessary to make informed decisions, and you should feel empowered to say “no” to any part of your treatment that doesn’t feel right to you. Don’t just assume that your doctor knows what’s best for you.

A good doctor will want to hear your concerns and encourages questions. Patient education, after all, is a central part of their job. And you are a key player on your health care team.

TIP: Remember that you have a right to ask questions. Make sure you understand all your doctor’s answers and ask follow-up questions if you don’t. If you have trouble remembering everything, take a friend or family member with you to your appointment and ask them to jot down some notes.

Why Do I Need This Medication?

Medical experts say the most important question you should ask your doctor is a relatively simple one: What’s my diagnosis?

People often visit the doctor with complaints of pain, but their provider never identifies the root cause of the pain. That’s especially true for patients suffering from chronic pain, which is a common symptom of a variety of conditions that can be challenging to diagnose.

Dr. Richard Blondell, a professor of family medicine and vice chair of addiction medicine at the University at Buffalo, told DrugRehab.com that an oft-repeated scenario he sees is a patient with ongoing, unexplained back pain who is prescribed narcotics right off the bat.

The quick fix seldom works. The patient then returns to the doctor, who increases their dose of painkillers, but never actually determines what’s causing the pain.

Identifying the precise cause of persistent pain may require considerable time, tests and patience — but it can also be lifesaving. Case in point: A patient with chronic back pain once came to Blondell addicted to opioids. The doctor performed a rectal exam and determined the patient had cancer.

Not every person with unexplained pain has an underlying condition as severe as cancer, of course, but getting an accurate diagnosis should always be the first priority, followed by treatment aimed at fixing whatever is wrong.

“Only then — if you know what’s wrong, and the patient is left with pain — then, can and should we start talking about pain treatment”— Dr. Richard Blondell

TIP: If your doctor is unsure about the cause of your pain, tell them you’d like a second opinion. A doctor worth his salt won’t be offended by the request. They may even be able to suggest a specialist who can get you the answers you need.

Understanding the Risks of Opioids: Overdose, Addiction & Side Effects

Opioids are potent nervous system depressants that can dangerously slow your breathing and even kill you. While less potent opioids and lower doses tend to cause fewer complications, there is no absolutely risk-free dose of an opioid.

The medications are also highly addictive and a person can develop a physical dependence on opioids within just a few days or weeks of use. The risks of developing an opioid addiction increases the longer you take them.

Unfortunately, doctors often fail to mention these risks. In April, the Times Union reported the results of a 2018 poll by the Siena Research Institute revealing that only half of the New Yorkers prescribed an opioid in the last two years were warned by their doctor about the risks of the medication.

If your doctor prescribes you an opioid, ask about these serious hazards associated with the use of opioids:

• Accidental overdose
• Physical dependence
• Addiction

Make sure you understand the signs and symptoms of an overdose and ask your doctor if you need a prescription for naloxone as a precautionary measure. The lifesaving drug can reverse an accidental opioid overdose. Having the antidote on hand is especially important it you have a history of addiction or have used opioids recreationally in the past. In most states, naloxone is available over the counter, and some insurance plans cover the cost of the drug. Contact your insurance provider to find out if your plan covers naloxone.

You’ll also want discuss other common reactions to opioids, such as: nausea, vomiting, itching, constipation, dry mouth, sleepiness, confusion, mental fogginess, depression and increased sensitivity to pain. Ask your doctor how to manage these side effects if they arise.

Before filling a prescription, ask your doctor or pharmacist how opioids will interact with other medications you take — and know what to avoid. Mixing opioids with alcohol, sedatives, muscle relaxers and sleeping pills is especially dangerous and can lead to an overdose.

TIP: If you are pregnant or could become pregnant, it’s essential to avoid using opioids. Opioids increase the risk of birth defects and increase the chances your baby will be born early or underweight. Infants exposed to opioids prior to birth may develop a painful condition known as neonatal abstinence syndrome.

Be Honest About Your Medical History

It’s important to have a frank discussion about your medical history. If you’ve struggled with substance abuse in the past, let your doctor know.

Depending on your situation, your doctor may still decide to prescribe you opioids. After all, there are inevitable situations, such as following a car accident or surgery, when nothing but an opioid will deliver adequate pain relief.

But if your doctor knows your background, they can incorporate important safeguards into your care plan.

Your doctor may ask you to sign a treatment agreement. Sometimes referred to as “opioid treatment contracts,” these voluntary agreements lay out specific expectations of behavior.

Typical contracts often require random drug testing, keeping follow-up appointments and not requesting extra or early prescriptions. Patients also promise not to sell or share their pills, doctor shop or fill their prescription at more than one pharmacy. Breaking any of the rules in the agreement can result in your prescription being terminated.

Regardless of your medical history, your doctor should screen you any risk factors for addiction.

Factors that may increase your chances of developing an opioid addiction include:

• A personal history of alcohol or substance misuse
• A family history of drug or alcohol use
• A history of childhood sexual abuse or other trauma
• Mental health conditions, such as depression, anxiety, attention-deficit/hyperactivity disorder, obsessive compulsive disorder, bipolar disorder and schizophrenia
• Stressful life events
• Cigarette use

If you’re in recovery and need to take opioids following surgery or for some other reason, there are important steps you can take to minimize your risk of relapse.

Enlist your spouse, parent or a trusted friend to hold on to your medication and manage your dosing, and ask them to keep an eye on you. Family members are usually the first to notice when something isn’t right.

It’s also a good time to activate your support network. If you’re active in a 12-step program, make sure to attend meetings or check in with your sponsor.

Stay in close touch with your physician throughout your treatment regimen. Let them know how the opioids are working and whether you’re experiencing any cravings or other signs of addiction. If you are struggling, ask for a referral to an addiction specialist.

TIP: If you feel you may be spiraling into the throes of addiction, called 1-800-662-HELP, the SAMHSA National Helpline. The free and confidential hotline can provide information about addiction and referrals for opioid addiction treatment.

Pain Has a Purpose

Medical experts say patients also need to have realistic expectations about pain and understand its purpose.

“Pain is there for a reason,” says Blondell. “A lot of times, if we hurt, it’s to remind us not to do something stupid. Pain protects us from further injuries.”

In fact, there are several types of pain that people can experience.

Nociceptive pain serves as a warning system to protect your body from extreme heat, cold and other destructive forces. When you accidentally touch a hot burner on a stove and reflexively pull back, this is nociceptive pain. Nociceptive pain is usually short-lived.

Inflammatory pain is typically longer lasting. It occurs after an injury or infection as the immune system responds to damage — and its purpose is two-fold. As immune cells infiltrate damaged tissue, the body’s repair process begins. But the ensuing tenderness and hypersensitivity is also protective because it discourages you from physical activity that might worsen the injury.

Unfortunately, opioids can mask that protective mechanism. A person who tears a muscle on the job, might be able to return to work once they’re “pumped full of Vicodin,” Blondell says, but chances are they’re going to engage in more activity that just makes them worse.

“No one ever absolutely has to have an opioid. These are for pain relief, and the body will decrease pain on its own over time as the healing process from an injury proceeds.”— Dr. Chris Johnson, Park Nicollet Methodist Hospital

For the past several decades, the medical community has been more aggressive in treating pain — a philosophy promoted both by opioid manufacturers and by well-meaning physicians who believed they could do a better job alleviating patient’s suffering.

Unfortunately, that’s led to a misunderstanding of the nature of pain and overtreatment with opioids.

Dr. Chris Johnson, an emergency room physician with Park Nicollet Methodist Hospital in Minnesota, told DrugRehab.com that patients need to understand that no “end organ damage” will result from pain alone.

While a blood thinner like Coumadin can mean the difference between life and death in a patient with blood clots, and antibiotics are essential for treating serious infections such as bacterial meningitis, a painkiller is a “life-improving comfort measure,” Johnson explains.

“No one ever absolutely has to have an opioid. These are for pain relief, and the body will decrease pain on its own over time as the healing process from an injury proceeds.”

TIP: Before starting on opioids for chronic pain, talk to your doctor about your treatment goals. Together, you should set realistic and measurable goals that establish expected levels of improvement for both pain and functioning. Your doctor should reevaluate you within one to four weeks.

Considering Opioid Alternatives

While opioids can be extremely effective in reducing acute pain, they are not a first-line treatment or routine therapy for chronic pain.

That’s because dugs such oxycodone and hydrocodone lose their effectiveness over time as the patient builds up tolerance to the medication.

In fact, with long-term use, opioids can even have the reverse effect and patients may become more sensitive to pain. This phenomenon is known as opioid-induced hyperalgesia. Extended use of opioids also increases your chances of addiction and overdose.

Blondell says that patients who use opioids for chronic pain should experience at least a 30 percent reduction in their pain levels. If they don’t, then the opioids are not the answer and they should look at other options.

Fortunately there are a number of over-the-counter medications and nonprescription remedies for treating persistent pain.

Non-Opioid Medications

In many cases, non-opioid painkillers, such as ibuprofen, acetaminophen, aspirin and naproxen, will work just as well as, if not better than, opioids — even for acute pain.

A 2017 study in the Journal of the American Medical Association (JAMA) found that emergency room patients with broken bones and sprains who were given a combination of ibuprofen and acetaminophen experienced just as much pain relief as did patients who received opioids, such as Percocet or a combination of Tylenol and codeine.

The findings echo other research showing that over-the-counter drugs can work just as well as opiods in reducing dental pain, pain from kidney stones and pain from chronic conditions, such as arthritis and back pain.

A one-year investigation by medical researchers at the U.S. Department of Veterans Affairs found that opioids worked no better than over-the-counter pain medications in reducing pain in patients with chronic hip, knee and lower-back pain. In fact, over the course of a year, the patients using opioids experienced slightly more pain than their counterparts on non-narcotic therapy.

Unlike opioids, which only block sensations of pain, anti-inflammatories such as ibuprofen and naproxen can actually reduce the inflammation associated with pain. If over-the-counter medications aren’t effective, there are other types of prescription medications that may reduce pain.

Some common non-opioid prescription medications used to treat pain include:

• Topical anesthetics, such as lidocaine or meloxicam
• Topical analgesics, such as capsaicin
• Nonsteroidal anti-inflammatories, such as Toradol, Mobic and Indocin
• Anti-seizure medications, such as gabapentin (Neurontin), that treat nerve pain
• Corticosteroid injections
• Certain types of antidepressants

All drugs, however, carry their own set of risks and side effects. Ask your doctor whether these non-opioid prescription medications may be right for you or if any non-drug therapies might help.

Non-Drug Pain Strategies

Non-pharmacological therapies and techniques can also reduce pain and are often superior to medications, particularly when it comes to chronic pain.

Breathing practices and medication, for instance, have proved to offer powerful pain relief. Other effective pain therapies include: acupuncture, therapeutic massage, the application of heat and ice, physical therapy and exercise.

Johnson says the “best method” for achieving lasting pain control is the adoption of behavioral strategies that help them return to a more normal state of functioning.

“Weight loss, exercise, mindfulness and improved social interactions are more effective than any of the treatments where the patient approaches the health care industry and says ‘fix me,’ at least as far as treating chronic pain,” says Johnson.

Other pain-relief techniques that don’t involve popping a pill include:

• Biofeedback
• Music therapy
• Relaxation techniques (such as meditation and mindfulness)
• Yoga and tai chi
• Acupuncture
• Hypnosis
• Transcutaneous electrical nerve stimulation (TENS)
• Cold laser therapy
• Ultrasound therapy
• Sprints, braces, walkers, orthotics
• Cognitive behavioral therapy

When they are needed for acute pain, opioids should be used for only the shortest time period necessary and at the lowest effective dose. In most cases, three days of opioids will suffice. Rarely will a patient require more than seven days’ worth of pain pills.

TIP: While the medical field is embracing an integrative approach to health care that combines conventional with complementary and alternative approaches, health insurers haven’t necessarily caught up. Check with your insurer to see if they cover specific treatments.

Know Your Responsibilities

Finally, if you are prescribed an opioid, know that you have an obligation to protect yourself and others.

Educate yourself about the drug you are taking, and follow your doctor’s instructions. Never take more than your recommended dose. And if you’ve stopped taking your pills for a few days, don’t suddenly start taking them again. Your tolerance may have dropped and the dose may be too potent.

Medications should also be stored out of the reach of children and adolescents and preferably under lock and key. Also be sure to engage the safety lock of your pill bottles each time they are opened.

Opioids can affect your ability to drive or operate heavy equipment and machinery. Ask your doctor what activities you should refrain from if you are taking opioids.

If you’re taking a prescription opioid, remember:

• Take your medicine as prescribed.
• Never share or sell your medications.
• Never mix opioids with other drugs or alcohol.
• Dispose of your unused opioids safely.
• Notify the police if your prescription is lost or stolen.

If you notice that you are developing signs of a physical dependence on your painkiller, let your doctor know sooner rather than later.

Often, the first sign of physical dependence on an opioid is an increase in pain. A patient may interpret the pain as a flare-up of their condition and mistakenly think they need a higher dose of painkillers.

“Patients should not wait until they experience nausea and other ‘flu’ symptoms to simply tell them they are now becoming dependent,” says Johnson. “The process begins much earlier than that. In fact, according to the Kaiser Family Foundation, dependence occurs in just two months.”