Opioid Analgesics are usually used to relieve moderate to severe pain and have their uses in patients with more severe Fibromyalgia related problems. However when using Opioids a lot of caution is needed. Opioids can have more and severe side effects than non Opioids. They can often be highly addictive and can cause physical dependence and tolerance.

The most common side effects include nausea, vomiting and constipation. There are also more concerning side effects which can cause problems with the breathing process and in the heart so misuse of Opioids can be very very serious.

My Personal Opinions

I have used morphine sulphate in various forms to help me with pain management. I personally recommend that you need direction from a good Pain team on how to and how not to use morphine. I managed quite well using morphine for over a year and managed to use it only when I needed to and more importantly not when I didn’t need to. Unfortunately after this time my condition deteriorated and I went from generally mobile to generally immobile. I have built up a tolerance from 20mg being enough to deal with most pain to needing in the region of 70mg or more for serious pain. I believe the problem lies in some direction from a neurologist and with my GP after I was discharged from my pain team. I was directed to use MST to help with Chronic Pain and Oramorph to deal with Breakthrough Pain. Before I knew it I was on morphine 24/7 and my average intake had skyrocketed following their advice and I found I had built a tolerance and signs of dependence. I have now stopped taking direction on pain management from my GP and refused to follow their recommendations and have asked for a Pain Team referral. I am trying very hard to both deal with pain all the time and keep my average morphine intake down but this is very very hard to do and my Summer appointment can not come soon enough. This is my own free choice and not following medical advice can be extremely dangerous and I do not recommend anyone does the same under any circumstances. I have included this as an example to anyone considering or starting to take Opioids that they need to be very confident in the quality of medical advice and be under constant management as Opioids are very very addictive and before you know it you have a tolerance and dependence. My advice is only use them if you are totally happy with the doctors who are managing your pain request constant monitoring for at least the first 6 months of use and question any decisions coming from your GP if they concern you.

Constipation

I am going to mention constipation in its own section as if your going to be using Opioids on a regular basis and find you can tolerate them you are highly likely to have problems with constipation. I have always been susceptible to constipation even before I started taking morphine. If you plan to take morphine regularly constipation needs to be something to expect and to discuss with your pain team. You are likely to need laxatives as well as Opioids to allow things to keep moving. This was something that was not even mentioned by my GP when they kept upping my doses of Morphine and I think this was highly neglectful. Constipation can be managed but if it isn’t it can cause serious problems the most extreme being blockages requiring surgery or perforations of the bowel. At its worst I was going over a month between bowel movements and this is not acceptable. I find I need to be on a few sachets of laxative each day to keep my bowel movements to at least weekly. I suffer a lot of pain, bleeding and piles anyway and my bowel movements are traumatic at the best of times. If your having trouble in this department then speak to your doctor and consider laxatives, stool softeners, latex gloves, glycerine suppositories, micro enemas and sanitary pads. Unfortunalty I keep a good supply of all of these at hand not just because of morphine.

Tramadol

You will probably find that Tramadol is the most used drug in this category. It is less addictive than morphine and causes less constipation. I have used Tramadol myself but unfortunalty it was not able to control my pain at that time. I found that I felt quite light headed on it and that is a side effect but it does not mean that everyone will feel the same. It can also have reported psychiatric side effect so it’s worth bearing that in mind as well.

A list of Opioids

Morphine
Oramorph
MST
Buprenorphine
Codine
Diphenoxylate
Dipopanone
Diamorphine
Dihydrocodeine
Alfentanil
Fentanyl
Remifentanil
Meptazinol
Methadone
Oxycodone
Pentazocine
Pethidine
Tramadol