Why Won’t My Doctor Prescribe Opioids for My Pain?
By Sarah Spelsberg, MD
If you have recently visited your doctor for pain management and were surprised when they did not prescribe opioids, you are not alone. Many patients wonder why these once commonly prescribed painkillers are now offered sparingly, if at all. The answer lies in the growing understanding of the risks associated with opioids and the shift toward safer, more effective pain management strategies.
Understanding Opioids and Their Risks
Opioids, such as hydrocodone, oxycodone, fentanyl, and morphine, are powerful medications that work by binding to receptors in the brain to block pain signals. While they can be highly effective for acute or severe pain, such as after surgery or for cancer-related pain, they come with significant risks. These risks have led to a public health crisis in the U.S. and other countries, prompting a reevaluation of their use.
- Addiction and Dependence:
One of the greatest dangers of opioids is their highly addictive nature. Even short-term use can lead to physical dependence, where the body adapts to the drug and requires more to achieve the same effect. Over time, this can spiral into addiction, characterized by compulsive drug-seeking behavior and misuse.
- Overdose Risk:
Opioids depress the respiratory system, and taking too much can slow breathing to a dangerous or fatal level. The Centers for Disease Control and Prevention (CDC) reports that opioid overdoses claim tens of thousands of lives each year in the U.S., often linked to prescription misuse or illicit opioids like fentanyl.
- Ineffectiveness for Chronic Pain:
Studies have shown that long-term opioid use is often not effective for chronic pain conditions, such as back pain or arthritis. In fact, prolonged use can lead to increased sensitivity to pain (a condition called opioid-induced hyperalgesia – fancy speak for medicine causing increased pain) and worsening of symptoms over time! We do not want to make you worse!
- Side Effects:
Common side effects of opioids include drowsiness, nausea, constipation, and confusion. In older adults, opioids increase the risk of falls and fractures, making them especially dangerous.
Why Your Doctor Is Hesitant
Given these risks, healthcare providers are now guided by updated prescribing guidelines, such as those issued by the CDC. These guidelines encourage doctors to consider non-opioid options as the first line of treatment for most types of pain. When opioids are prescribed, they are typically for short durations and at the lowest effective dose. Your doctor’s goal is to manage your pain effectively while minimizing the potential for harm.
Doctors also recognize the importance of tailoring pain management to individual needs. They may recommend alternatives like physical therapy, acupuncture, cognitive behavioral therapy, or non-opioid medications such as acetaminophen, ibuprofen, or antidepressants, depending on the type of pain. Pain receptors overlap with depression receptors in the brain. These options often have fewer risks and can be just as effective for certain conditions.
A New Approach to Pain Management
If you feel your pain is not being adequately addressed, talk openly with your doctor about your concerns. Pain management is evolving, and while opioids may not always be the answer, a collaborative approach can help you find a treatment plan that works for you. The focus is now on managing pain in ways that prioritize safety, quality of life, and long-term well-being.
By understanding the risks of opioids and exploring safer alternatives, you and your doctor can work together to address your pain effectively and responsibly.
Dr. Sarah Spelsberg is an Emergency Medicine Resident at UNC Health Southeastern. In addition to offering services you’d expect from a community health care system, UNC Health Southeastern provides a number of specialized services that are unique to our healthcare system and not available anywhere else in the region. To schedule an appointment, call our referral line at (910) 735-8864. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a Frequently Asked Questions article, email unchsoutheasterninfo@unchealth.unc.edu.
