 Opioid Use in Treating Chronic Headache
Frequently Asked Questions
Click here to read
the content disclaimer
Opioid Use in Treating Chronic Headache
(by Joel Saper, M.D.)
What is the difference between short-acting
and long-acting opioid medications?
The difference between short-acting and long-acting opioid medication involves the
duration of analgesic effect. Generally speaking, short-acting opioids work for
3-4 hours, peaking at approximately 2-3 hours after administration. Long-acting
opioids are designed to work from 24 hours to 8-12 hours per dose. Many patients
using long-acting opioids, however, require more frequent dosing for ideal pain
control. The Duragesic patch (the narcotic fentanyl is released from the patch to
the skin) has a duration of action for up to 72 hours per patch application.
Back to Top | Back to FAQs
What are common side effects for
opioid medications?
All opioid medications cause physical dependency. This means that with frequent
usage, the body becomes physiologically dependent on the medication and sudden discontinuance
will produce withdrawal symptoms. Some patients also become emotionally or psychologically
dependent on these medications, usually from their effect on mood, which includes
a "buzz" feeling and tranquilization. "Addictive disease" is defined as physiological
and/or psychological dependency, in conjunction with inappropriate drug-seeking
behavior, including usage for reasons other than pain, multisourcing, forgery, etc.
Relatively few patients with legitimate pain fulfill the criteria for "addictive
disease" as defined in this way.
Back to Top | Back to FAQs
Tell us more about the use of long-acting
opioid medications for chronic pain including migraine headache
MHNI professionals are recommending in their various teaching forums and publications
that certain guidelines may help to define treatment-eligible patients for opioid
therapy. Except rarely, patients should not be placed on chronic opioid treatment
unless they have demonstrated clear and convincing failure to respond to a variety
of other less potentially troubling therapies. We do not think this treatment is
appropriate for young patients with chronic headache, patients with personality
disorders, or those with a history of chronic misuse of medication.
Of concern is the potential long-term effects of chronic opioid treatment, particularly
in middle-aged or young patients. There is some concern that long-term usage could
in fact alter forever the physiological mechanisms of pain modulation in the central
nervous system, and thus render a patient more vulnerable to pain whenever the medication
is reduced. Other long-term risks have simply not been studied.
Back to Top | Back to FAQs
MHNI recently completed a 5-year
follow-up study on the use of long-acting opioid medications for the treatment of
intractable headache. What were the results of this study?
The results of MHNI's 5-year study show that less than 25% of chronic headache patients,
when given opioids daily, actually benefited in a clear and measurable way. Over
half of the patients requested or required discontinuation of the medications soon
after they were administered. Another 25% continued to take the medication with
only marginal benefit. Twenty-three percent (23%) showed substantial benefit. Relatively
few patients who reported feeling better reduced the use of other medications for
headache.
Unfortunately, many patients who successfully took the narcotic medications demonstrated
misuse patterns, which included altering dosages without physician approval, losing
certain medications, etc.
One positive finding was a reduction in hospitalization and emergency department
usage in the group that improved. The results of this study thus suggest that a
small but important percentage of patients who have failed the most advanced care
for the treatment of their head pain will benefit from chronic opioids. Such patients
must be selected carefully and must be responsible and compliant with treatment
limitations.
Back to Top | Back to FAQs
|