Common Side Effects Related to Opioids

Expert panelists Joseph Pergolizzi, MD, and Christopher Gharibo, MD, discuss the spectrum of opioid-related side effects that often concern chronic pain patients and prescribers.

According to Pergolizzi, the common side effects of opioid treatment include:

• Addiction, though “a good opioid risk management plan will alleviate some of that anxiety”
• Gastrointestinal problems like opioid-induced constipation (OIC), particularly among older patients
• Issues related to the central nervous system (CNS)
• Dysphagia
• Tinnitus, or ringing in the ears
• Heartburn

However, Pergolizzi notes “the practitioner needs to be thinking about not just the top-line type of adverse events that you can read in the package insert, but the additional ones, too.”

“Chronic pain is not monogamous, (as) patients come with multiple comorbidities, (such as) diabetic peripheral neuropathy, painful peripheral neuropathy, diabetes, hypertension, (and) hypercholesterolemia,” Pergolizzi explains. “So, you have to be cognizant of clinically relevant pharmacokinetic and pharmacodynamic drug-drug interactions. Whether they are stealth or silent, or more obvious, it’s something you have to realize.”

Looking at acetaminophen combinations, in particular, Gharibo says toxicity becomes a serious concern when the opioids are taken in conjunction with other acetaminophen products.

“Often, patients are not aware of how much acetaminophen they’re consuming or how much anti-inflammatories they’re consuming, and the damage begins quite promptly,” Gharibo cautions. “Once you begin to exceed 3,000-4,000 mg of acetaminophen or ongoing anti-inflammatory therapy, the end organs begin to suffer.”

To avoid potential toxicity, Gharibo recommends “prescribing the non-combination forms of short-acting medications that do not have an anti-inflammatory or acetaminophen … in a way that encourages that they be taken on an (as-needed) basis, rather than around the clock.”