Not all patients with neuropathy need powerful pain medication to treat their symptoms. In most cases, doctors will try other forms of treatment before progressing to opioids, a type of narcotic drug that works by binding to opioid receptors in the brain, spinal cord, and other areas of the body. Opioids, such as codeine, oxycodone, oxycontin and morphine carry risks that make some patients reluctant to use them and some doctors reluctant to prescribe them.
However, for patients that do not experience relief with other treatments, opioids can offer powerful and effective relief. With chronic pain, it is extremely important to stay on top of your symptoms, rather than only taking medication when symptoms are at their “worst.” The true danger lies in the possibility that the untreated chronic pain in one part of the body will become centralized in the brain or spinal cord. Untreated pain from the extremities can cause tissue destruction in the central nervous system, which is much harder to treat effectively.
There are several reasons that patients are reluctant to take these types of medications, including fear of addiction or dependence and intolerable side effects, such as drowsiness, constipation, nausea and, with elderly patients, an increased risk of falls or cognitive problems.
However, there are several things you and your doctor can do to help minimize the risks while achieving the benefits of this form of therapy.
- Pharmacogenetic (DNA) testing can help determine the most effective medications and dosages. Just as different people have different tolerances and sensitivities to food, different people metabolize medications differently. Many prescriptions drugs rely on enzymes produced in the liver to fully activate. A simple swab of the inside of your check allows for a detailed analysis of each patient and whether certain drugs may be more or less effective.
- Monitoring is a must. A regular monitoring plan important to achieving the maximum benefit and minimizing risk. Be sure to tell your doctor of any changes to how you tolerate the medication, including increased or decreased effectiveness. Be sure to take the medication exactly as prescribed; if the medication is not working effectively, or causing intolerable side effects, discuss this with your doctor before making any changes. Never stop taking a medication without consulting with your doctor.
- Your hormone and vitamin levels can have a significant impact on the effectiveness of your medications. Even when a medication is selected specifically for you, other factors can have an impact on the amount you need to achieve symptom relief. Lowered hormone levels and a deficiency of certain vitamins, such as B12 and D, can result in a patient needing larger doses to reach maximum effectiveness. Long term use of opioids can create these deficiencies. Your doctor can help determine if hormone and/or vitamin supplementation is right for you.
- Your diet can have an impact on the effectiveness of your medication. Certain foods and supplements are known to be inducers (stimulate) or inhibitors (decrease) of enzyme production that is necessary for drug metabolism. Your doctor should provide information on diet changes that may have an impact on the effectives of your medication.
- Topical medications may be a good alternative. There are a number of advantages to topical administration of medication. These include avoidance of going through the liver for metabolism, ease of application, less fluctuation of drug levels, efficacy at a lower dose, ability to be site-specific, improved adherence and avoidance of some of the major risks of oral medications, such as drug-drug interactions and systemic side effects.
Opioid therapy carries risk, but for some patients, it can be an important part of their treatment plan. Talk with your doctor about your concerns regarding this therapy and determine if it may be right for you.
If you or someone you know is experience symptoms of neuropathy, our neuropathy experts can help. With locations across the US, we are easily accessible and here to help.
The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
@US Neuropathy Centers, 2018