Chronic Pain and Opioid Prescribing

People with heart failure (HF) are at an increased risk of persistent pain, also known as chronic pain. In fact, up to 85 percent of people with HF experience pain.¹

Managing chronic pain in people with heart failure may be more challenging than in those without. This is because people with HF are often told not to take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Some people with HF are also not able to take maximum doses of acetaminophen (Tylenol), especially if they are on warfarin, a common blood thinner. Opioids are another class of medicine used to treat pain, and sometimes are prescribed as a last resort for people who cannot take or do not respond to Tylenol and NSAIDs.^1,2

What are opioids?

Opioids are a type of pain-relieving medicine. Some are made from the poppy plant, and others are created in a lab. Sometimes, opioids are formulated with other pain medicines. For example, tramadol and codeine can be combined with acetaminophen (Tramacet and Tylenol #3, respectively). Examples of prescription opioids include:^3,4

• Codeine
• Tramadol
• Morphine
• Fentanyl

How do opioids work to relieve pain?

Opioids work differently than Tylenol and NSAIDs to relieve pain. That is why people can be prescribed all 3 types of medicines if needed. Specifically, opioids work to relieve pain at the brain level – meaning they reduce the perception of pain. Some opioids are stronger than others. For example, fentanyl is 100 times stronger than morphine, and codeine has one-tenth the strength of morphine.^4,5

What are side effects of opioids?

We have all heard of the opioid overdose crisis, which is partly due to one of opioids' most serious side effects: the risk of dependency, or addiction. Most overdose deaths in the United States are caused by opioids.^6,7

Some other side effects of opioid use include:⁶

• Drowsiness
• Nausea
• Constipation
• Slowed heart rate
• Shallow breathing

Opioid prescribing

Opioids used to be prescribed more often, but growing concerns about the impact of the opioid overdose crisis have resulted in stricter rules. Before prescribing an opioid, most doctors will ensure that:⁸

• Other pain medicines have been tried
• A person is experiencing a high level of pain
• A person has little to no history of substance dependency and is not at risk for opioid addiction
• The benefit of treatment outweighs the potential risk

Understanding treatment goals with chronic pain from heart failure

If you are being assessed for chronic pain, speak to your healthcare team about what you hope to gain from pain medicine. Sometimes, the goal of pain medicine is not to completely eliminate pain. Often, the goal is to reduce pain in order to continue the normal activities of your daily life.⁸Have you had a conversation with your healthcare team about the use of prescription opioids to manage chronic pain from heart failure? Share your experience below.