A big part of managing pain is learning about the different techniques and strategies available. It is possible to improve daily functioning and continue healthy habits by learningwomen in the field strategies to help reduce the amount of impact pain has on these activities. The information provided may help you and your health care provider discuss your pain and options for pain management.

Each person experiences pain differently; some people have pain that lasts a short time, while others have pain that lasts much longer (chronic).

Depending on the type and the duration of your pain there are different approaches. Often a varied approach is best when creating your pain management plan. Approaches can include:

  • Acupuncture
  • Physical therapy
  • Medications (opioid and non-opioid).

Many people may think that medication is the only way to control chronic pain. While both opioid (medications containing an opium compound) and non-opioid medications may be used at times as part of a pain treatment plan, it is important to also include other treatment strategies. These are called self-management strategies that, combined with your ongoing medical treatments, can help you live a more healthy life and is often the best approach. It's also best to be familiar with opioid medications including safety guidelines, side effects, and how you and your provider can work together to manage your opioid use.

Medication lockGeneral Safety:

To protect yourself and others, you must understand how to use opioid medications safely and responsibly. Because opioid medications can make you sleepy and/or confused, or have other side effects, they make it dangerous for you to do normal tasks like driving a car, riding a bike, operating machinery, and making important decisions. Avoid these activities after starting a new opioid or if your dose is adjusted until you know how your medication will affect you. If the medication makes you feel drowsy, dizzy, or confused, you should not drive or operate machinery! If this is the case, talk with your doctor about lowering your dosage or trying a different medication. Remember that when you take opioid medications, you are responsible for your safety and for the safety of those around you.

  • Opioids can harm an unborn baby. If you are pregnant or planning to become pregnant, tell your doctor.
  • Your opioids are for you and only you. Do not share them with anyone, and always keep your medications in a locked cabinet out of reach of children and out of sight of others.

If you are prescribed opioids:

  • Use them only as instructed by your doctor. Never take opioids in greater amounts or more often than prescribed.
  • Avoid using the following types of drugs while taking opioids:
    • Alcohol
    • Benzodiazepines (such as Xanax and Valium), unless specifically advised by your doctor
    • Muscle relaxants (such as Soma or Flexeril), unless specifically advised by your doctor
    • Hypnotics (such as Ambien or Lunesta), unless specifically advised by your doctors
    • Other prescription opioid pain relievers
  • Work with your doctor to create a pain management plan, and consider non-opioid options
  • Follow up regularly with your doctor
  • Talk to your doctor about any and all side effects and concerns
  • Store opioid pain relievers in a safe place and out of reach of others
  • Do not sell or share your or anyone else’s prescription opioid pain relievers

Find your community drug take-back program or your pharmacy mail-back program to safely dispose of unused prescription opioid pain relievers. For a list of DEA collection events near you, please visit www.wmr.saccounty.net

Medication sample pillsMedication Interactions:

Since opioids can be dangerous when they interact with many other substances, you should tell your doctor about any and all medications you are taking or planning to take, including prescription and over the counter (OTC) medications. Mixing opioids with other substances is one of the most dangerous things you can do!

Taking opioids along with certain allergy medicines (like Benadryl) or with sleeping aids (like Ambien, Lunesta, or Unisom) can seriously increase the chance of life-threatening side effects like slowed breathing, increased drowsiness, and decreased alertness.

Many opioid medications are a combination of both an opioid and acetaminophen (Tylenol). It is important to not take any extra Tylenol in addition to the prescribed pain medication in order to avoid a Tylenol overdose.

Benzodiazepines, which are sleeping aids or anti-anxiety medicines, can be especially dangerous if taken along with an opioid pain medication. Most accidental deaths from opioids involve combining them with benzodiazepines, which include: Valium, Ativan, Xanax, or Restoril. When combined with opioids, these medications slow down the activity of your brain and spinal cord so much that you could stop breathing.

Medication bottle with words side effects

Even if opioids are taken the way your doctor says to, they can have uncomfortable and even dangerous side effects. Common side effects include:

  • Constipation which can cause serious problems such as hemorrhoids or bowel obstruction.
  • Lowered testosterone levels
  • Sleepiness and drowsiness
  • Increased sensitivity to pain
  • Nausea, vomiting, and dry mouth
  • Confusion
  • Depression
  • Itching and sweating
  • Tolerance which means you might need to take more of the medication for the same pain relief
  • Physical dependence which means you have symptoms of withdrawal when the medication is stopped

Opioids can also cause life-threatening problems that can lead to death such as:

  • Trouble breathing during sleep
  • Overdose

Remember, your health care provider is a partner in your pain treatment plan. It's important to talk about any and all side effects and concerns to make sure you are getting the safest and most effective care.

medication pills

Even if you take your medicine the way your doctor tells you to, there is still a risk for dependence, tolerance, and addiction.

Dependence means a person’s body feels like it needs a substance in order to function. This is normal. If you are a coffee drinker, you might already know how this feels.

Tolerance is another risk. Your body will get used to the medication. Over time, you might feel like you need to take more to get the same level of pain relief. And if you stop taking it, you can experience withdrawal symptoms like sweating, nervousness, nausea, vomiting, and diarrhea. Because withdrawal can be harmful as well as uncomfortable, you should talk to your doctor before making any changes to your dosage.

Overdose is a real risk

Patients taking prescription opioids are at risk for unintentional overdose or death and can become addicted. From 1994 to 2014, more than 165,000 persons died from overdose related to prescription opioids in the United States. Up to 1 out of 4 people receiving long-term opioid therapy in a primary care setting struggles with addiction.

Learn the signs of opioid overdose and educate those around you. Three signs of overdose are: tiny, pinpoint pupils, slow breathing, and unconsciousness. If someone has overdosed, a Naloxone kit can be used to save them. You can get a kit from a pharmacist without a prescription, but it may not be covered by your medical insurance.

While taking opioids, do not drink alcohol or use any illegal substances like cocaine, heroin, methamphetamine, or non-prescribed pain medications. If your doctor feels your safety is at risk by taking opioids in addition to other substances, they may have to reduce your prescription or stop it completely.



Caution sign with clouds behind itOpioids are powerful medications that can produce significant side effects, including constipation, nausea, confusion, and respiratory depression, which can sometimes lead to death. Although opioids may be effective in treating many different types of pain, long-term opioid use can result in physical dependence, making it difficult to stop use even when the original cause of pain is no longer present. Some medical research shows that long-term use of opioid medications for pain can actually make pain worse, and more difficult to control.

Data from the Centers for Disease Control and Prevention show that in the last 20 years, doctors have significantly increased the number of opioid medications they prescribe. With this increase in opioid prescriptions has come an increase in prescription opioid abuse. Your doctor is committed to providing you the best, and safest, care possible. Providing you with both optimal pain relief and careful management of opioid medication usage is an important priority of your health care team!

Some statistics:

  • In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.
  • “More than 40 Americans die each day from prescription opioid overdoses, ” according to CDC Director Tom Frieden, M.D., M.P.H.
  •  In the past decade, although the death rates for the top leading causes of death such as heart disease and cancer have decreased substantially, the death rate associated with opioid pain medication has increased. 
  •  In 2013, an estimated 1.9 million persons abused or were dependent on prescription opioid pain medication.
  • From 1999 to 2014, more than 165,000 persons died from overdose related to opioid pain medication in the United States.

The Opioid Patient- Prescriber Agreement (PPA) is an agreement between you and your provider. The Opioid PPA is a tool for becoming informed about the benefits, risks, limitations, and safe use of opioid medicines. It is designed to help create an open conversation between patients and providers. As partners in managing your chronic pain and your opioid medication, you and your provider will routinely talk about your personal health goals, medication history, treatment plan, side effects and precautions.

Signing of a PPA documents the understanding of the agreement between a provider and a patient. This allows your healthcare team to better facilitate your care as well as improve communication between yourself and all your healthcare providers on your behalf.

Download and print a copy of the PPA

When you are no longer taking opioids, it is important you dispose of them safely. Talk to your pharmacist about options to dispose of them safely, or drop them off at a Drug Enforcement Administration (DEA) event.
For a list of DEA collection events near you, please visit www.wmr.saccounty.net

Getting help and resources

If you or someone close to you needs help for substance abuse problems, talk to your doctor or call SAMHSA’s National Helpline at 1-800-662-HELP or go to SAMHSA's Behavioral Health Treatment Services Locator.

If you have questions about any medicines, call the U.S. Department of Health and Human Services Poison Help Hotline at 1-800-222-1222.

Tools and references for patients:

  • Pregnancy and Opioid Pain Medications – Women who take opioid pain relievers should be aware of the possible risks during pregnancy
  • Guidelines Patient Poster: Manage Your Pain, Minimize Your Risk
  • JAMA Patient Page: Opioids for Chronic Pain


Pain management class schedule