Harvard Health Letter

Pain relief, opioids, and constipation

Controlling pain is an important part of modern medicine, and opioid drugs do a great job of it, but constipation is a side effect.

An 87-year-old man with well-managed heart failure, an enlarged prostate gland, and poor eyesight got up in the middle of the night to open the curtains. He tripped over a space heater and wrenched his already-bad back. He was prescribed a strong pain reliever, Vicodin, which is a combination of a drug chemically related to morphine and acetaminophen. Several days later, writhing in pain from constipation, he was taken by ambulance to the emergency room and admitted to the hospital.

People who carry on despite minor aches and pains are admirable. But the stiff upper lip, if taken too far, can be a big mistake. Sometimes pain is an important warning sign of a serious underlying problem that calls for early treatment. The heart attack that announces itself with chest pain is a clear example of pain ignored at great peril. Early recognition and treatment of some painful conditions — migraine headaches, for example — can keep them from escalating. A migraine headache treated with medication as it begins can end relatively quickly. But even mild pain can have serious consequences if left untended. Persistent pain tips some people into depression; researchers are beginning to find overlap in the brain chemistries of depression and pain. Pain from arthritic joints can throw off your gait and balance, so a fall becomes more likely. It's difficult to sleep well if you're battling pain, and that can start a vicious cycle: pain often gets worse with lack of sleep.

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