Tramadol can be taken with ibuprofen

Opioids for persistent severe pain

What are opioids and how do they work?

Opioids are tried and tested pain relievers. They contain opium-like ingredients that occur naturally in the opium poppy. The best known is morphine (formerly: morphine). Opioids specifically inhibit the transmission of pain, especially in the brain and spinal cord.

They are also formed by the body itself and released during stress. They suppress sudden pain. If the pain is particularly severe or persistent, these endogenous substances are soon exhausted. Then sometimes artificially produced opioids help, for example in the form of a tablet.

When are opioids used?

Opioids are an important part of pain management for people with cancer. For other long-lasting pain, however, opioids are not generally more effective than other pain relievers. This pain should therefore not be treated exclusively with opioids. Usually a combination of medicinal, physiotherapeutic and psychological measures is used. You should decide together with your doctor which therapy is suitable for you. Your additional illnesses, preferences for certain dosage forms as well as the benefits and harms of the various forms of treatment are taken into account.

For some diseases such as nerve pain in diabetes, chronic pain with joint wear, chronic back pain and after shingles, high-quality studies have shown that opioids are effective for up to 3 months. In the opinion of experts, treatment can be attempted for other causes of pain. Opioids can be taken for longer than 3 months if they have previously been effective and well tolerated. Often those affected cannot clearly say whether the pain reliever is working well. Lowering the dose or stopping the opioid can be used to check whether the pain is increasing again.

When is opioids not recommended?

Opioids should not be used for: migraines, tension headaches, chronic pelvic pain in women, irritable bowel syndrome, chronic inflammatory bowel disease, chronic pancreatitis, during pregnancy, fibromyalgia syndrome and mental disorders with chronic pain such as depression. Opioids have little or no effect on these diseases and the side effects predominate.

Are opioids addictive?

During treatment with opioids for longer than 4 weeks, physical dependency (habituation) can occur, but does not have to be. This is normal and occurs with almost all drugs that are taken for a long time. However, this doesn't mean being addicted. Addiction is the uncontrolled, improper, and compulsive use of a drug. If your doctor prescribes an opioid for chronic pain, the risk of addiction is low.

If opioids are suddenly stopped, withdrawal symptoms such as restlessness, runny nose or diarrhea develop. They can be avoided by gradually stopping the opioid ("tapering off") in consultation with your doctor.

Special features when taking

It is important to take it regularly. This is the only way to achieve consistently good pain relief. Under no circumstances should you take opioids as needed, delay taking them, or change the dose on your own. This can cause considerable pain again.

What you can do yourself

  • Let your doctor know in detail about your symptoms, other illnesses and wishes, so that you can choose the right pain reliever together.

  • Work out realistic goals together, such as reducing pain intensity by about a third and improving everyday functions, such as resuming work or sleeping better.

  • Talk to your doctor if you have the feeling that pain treatment is not working well enough. Report any abnormalities and side effects. There may be a better drug for you.

  • Tell your doctor about your fears and reservations about opioids.

  • Take opioids as directed. It is important to take them at regular intervals, in sufficient doses, and for long enough.

  • Get a plan detailing how to take your medication.

  • Do not drive or use dangerous machines during the setting and conversion phase from opioids.

  • Relaxation techniques can help you reduce tension, anxiety, and pain.

  • Exchanging ideas with other people affected can be helpful. Visit a support group.

  • Try to distract yourself from your pain by doing things that are comfortable for you, such as spending time with friends or animals.

  • Never pass on medicines, including pain relievers. Other people should always contact their doctor themselves.
June 2018, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians