Patients' Perspective
Patients' Reluctance to Take Opioids for Intractable Pain Relief

After patients report their pain to their healthcare providers and receive opioid treatment, some are reluctant to or simply don’t take their prescribed opioids because they are:^11,12

• concerned about becoming dependent or addicted
• afraid to "use up" the analgesic effect of their pain medication
• fearful of severe side effects

Fear of addiction

Anti-drug propaganda has been so successful in convincing people that "anyone who takes drugs becomes an addict" that pain patients who take opioids for intractable pain are typically categorized with drug abusers. As a result, pain patients do not take their pain medication properly because they believe they will become addicts.

In a survey of over 200 pain patients, 82% believed that they could become addicted to their pain medication easily.¹¹ In another survey of over 200 pain patients, 27.3% of patients feared addiction from their pain medications, and 17% of them did not take their medication because of this fear of addiction.¹²

The truth is, as Dr. Nora Janjan, co-founder of the Multidisciplinary Metastatic Bone Pain Clinic, explains, "Addiction is behavior, not a physiologic response. What we think of as an addict is someone whose desire for drugs overwhelms everything they do, how they live. Our patients don’t do that. In fact, once the cause of the pain is treated, most patients will take themselves off the drugs." ¹⁴ In fact, studies show that addiction marks less than 1% of those taking appropriate levels of opioids for pain management.^5,6

Now, you may be asking, what is the difference between a drug addict and a patient taking opioids for intractable pain relief? Although not proven, researchers believe that pain patients and addicts respond to opioids differently because the nervous pathway that transports intractable pain develops little to no tolerance to opioids. The nervous pathways that transport sudden, sharp pain and pleasure do develop significant tolerance to opioids.¹⁵

Using up pain medication too soon

Many patients refuse to take all of their pain medication because they fear that their medication will not be effective with continued use.^13,14 In fact in a survey of over 1,000 US adults, 72% believed that "if you take medication when you don’t really need it, then when you do need it, it won’t work." ¹³ In another survey of over 200 pain patients, 60% believed that their medication should be saved for when they really needed it.¹¹

The truth is, opioids do not have a ceiling dosage where they cease to relieve increasing pain. Therefore, pain patients should feel comfortable taking appropriate amounts of opioids for their pain because there is no chance of opioid treatment "running out" of effectiveness.⁴

Fear of powerful side effects

Patients are afraid that if they take opioids to relieve their pain they will experience powerful side effects.¹⁴ This, however, is not the case. Patients can take increasing doses of opioids, as pain persists, without severe side effects.⁵

Of the side effects that do occur while taking appropriate amounts of opioids, constipation, nausea, and vomiting are the most severe. Nausea and vomiting usually subside after the first week of treatment. Constipation may continue further but can be treated with a laxative.¹⁶