Oxycodone for Chronic Pain Management

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Oxycodone is one of the oldest opioid medicines used to treat acute and chronic pain in a variety of conditions. It is effective for the management of chronic pain but like all other opioids has significant side effects and risks and is subject to non-medical misuse and abuse.

Use in Chronic Pain Management

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According to the U. S. National Library of Medicine, oxycodone is used to treat moderate to severe acute and chronic non-cancer and cancer derived pain. A semi-synthetic opioid derivative of the opium poppy plant, oxycodone has been used for the treatment of pain in the United States since 1939.

Pain Conditions Treated

Oxycodone, like other opioid medicines, is usually prescribed when non-opioid drugs are not effective in treating chronic pain. It is used for the following chronic pain situations:

  • Back and other musculoskeletal pain
  • Nerve pain, such as in diabetes or after herpes infection
  • Headaches
  • Post surgery
  • Sequelae of injuries
  • Cancer: according to a 2011 review in Palliative Medicine, oxycodone is as effective as morphine and hydromorphone for treatment of chronic cancer pain.

How Prescribed

Oxycodone comes as a tablet, capsule, or in liquid and is available as immediate release or delayed, extended release. The starting dose of the drug or adjustments to the dose is based on an individual's situation. A doctor usually starts a patient on a low dose and increases it if needed, depending on the level of pain and response to the drug. Oxycodone may be continued for years under a doctor's close supervision if a patient's pain fails to improve with other alternatives.

  • Immediate release oxycodone: According to the Mayo Clinic, the immediate release form of oxycodone comes in 5 to 30 milligrams doses. Typical starting dose is 5 to 15 milligrams every four to six hours. Pain relief can start in 10 to 15 minutes.
  • Extended release oxycodone: Oxycontin®, the extended release form of oxycodone, comes in a tablet of 10 to 80 milligrams, and a usual starting dose is 10 milligrams taken every 12 hours. It starts to take effect about an hour after ingestion, and the oxycodone is released slowly at intervals instead of all at once.
  • Combination oxycodone: Combinations forms of oxycodone, such as Percocet® (oxycodone and acetaminophen) and Percodan® (oxycodone and aspirin) contain lower doses of oxycodone and are usually prescribed for the treatment of mild pain.

Drug Interactions

For safe prescribing of oxycodone, a doctor needs to know if a patient is taking other medicines. Many other prescription and nonprescription medicines, vitamins, and other supplements compete with oxycodone for metabolism in the liver. When they compete with oxycodone, they can change its effects in the body and increase the chance of side effects and risks. According to the U. S. National Library of Medicine reference, interacting medicines include:

  • Other opioids
  • Sleep medicines, tranquilizers, and sedatives
  • Antibiotics
  • Antihistamines
  • Antidepressants
  • Diuretics
  • Glaucoma drugs
  • Drugs used to treat opioid addiction, such as buprenorphine naloxone
  • Herbal medicines

Benefits and Pros

Oxycodone is effective for long-term treatment of moderate to severe chronic pain when it is prescribed in appropriate doses and monitored carefully by a physician. According to a 2008 review in Current Medical Research and Opinion, it is effective for a variety of sources of pain and is more potent and better tolerated than morphine.

Extended release Oxycontin® is most suitable for people who need round-the-clock medicine and a longer lasting effect, or who need the convenience of less frequent doses. Since 2013, it is approved by the FDA only for the treatment of severe chronic pain, although doctors may still choose to prescribe it for moderate pain.

Cons and Risks

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Side effects and the risks of oxycodone make it challenging for some patients and doctors to manage the drug.

Side Effects

Like other opioids, the most common side effects include:

  • Euphoria and relaxation
  • Drowsiness and sedation
  • Depressed mood
  • Dizziness and light-headedness, fainting, and headache
  • Constipation, nausea, and vomiting
  • Dry mouth and dry eyes
  • Skin itching, rash, and flushing
  • Slow heart beat and slow breathing
  • An increase in response to and a heightened sense of pain (hyperalgesia)
  • Hormone imbalances and low estrogen and testosterone (hypogonadism), impaired ovulation, sperm production, and infertility

In a survey published in 2011 in the Journal of Opioid Management, 84% of patients reported side effects from oxycodone.

Risk of Overdose

Misuse and abuse of oxycodone can lead to overdose, respiratory arrest, and death. This risk is greater if it is taken with other substances, such other opiates, alcohol, tranquilizers, sedatives, or other drugs of abuse.

Risk on a Pregnancy

An additional concern is the use of oxycodone for chronic pain during pregnancy. This raises the risk of poor pregnancy outcomes, including preterm birth and low birth weight. If taken throughout pregnancy, oxycodone can stay in a baby's system until birth and cause withdrawal symptoms, associated with the neonatal abstinence syndrome.

Risk of Tolerance and Dependence

Long-term use of oxycodone can cause:

  • Tolerance, with the need for higher and higher doses to get the desired pain control
  • Physical dependence, which causes withdrawal symptoms if the drug is stopped abruptly
  • Psychological dependence, which causes a mood disorder, such as depression, when a person is off the drug

Risk of Abuse and Addiction

The risk of addiction from long term use of opioids for chronic non-cancer pain is low, according to a 2010 Cochrane Database Systems Review analysis of several studies. However, long term misuse and abuse of oxycodone or other opioids increases this risk of addiction.

Inappropriate use includes taking oxycodone in higher doses, or using it more frequently than prescribed, or taking it by other routes instead of by mouth. Addiction to the drug causes compulsive craving and drug seeking behaviors. How long it takes to become addicted depends on many factors. People who are most vulnerable include those who have a mood or a psychological disorder, a genetic vulnerability, or who abuse other drugs.

Extended-release Oxycontin® is more frequently abused and is more risky than the quick-acting oxycodone because it contains a larger amount of the opioid. If it is dissolved in the mouth before swallowed, or is snorted or injected, the bigger "hit" of the drug gives a greater "rush," increasing the chance of repeated use.

Safety and Precautions

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Oxycodone is safe for the treatment of chronic pain when taken as prescribed. However, long-term use for non-cancer pain is controversial. The current epidemic of overuse and inappropriate use of opioids and their potential adverse outcomes is a big part of the controversy. According to the Centers for Disease Control (CDC), since 1999 there has been a four-fold increase in the use of opioid pain medicines. An effort by healthcare providers to improve chronic pain management helped fuel this increase.

Precautions Against Abuse and Addiction

A doctor's challenge in prescribing oxycodone is to manage a patient's pain safely and effectively while limiting adverse outcomes and the risk of abuse or addiction. Federal regulations, state level policies, electronic prescription drugs monitoring programs (PDMPs), and opoid prescribing guidelines help doctors in this endeavor.

Precautions a doctor can take include the following:

  • Considering non-opioid treatments first and using oxycodone only when these other options fail
  • Prescribing the lowest dose for the shortest time needed
  • Assessing a patient's risk for abuse of the drug if long-term use is needed
  • Counseling a patient on inappropriate use and the potential for addiction if the drug is misused
  • Constant monitoring of a patient's oxycodone dose, the response to the drug, and the continuing need for the drug

You can take the following precautions to reduce the chance of inappropriate use of oxycodone and the associated risks:

  • Guard against taking oxycodone other than as prescribed.
  • Avoid taking the drug with other addictive or recreational drugs.
  • Don't use other people's drugs.
  • Don't share your oxycodone to decrease the risk of diversion for non-medical purposes.
  • Talk to your doctor about alternative treatment options or when and how to stop oxycodone if you no longer need to take it for pain.

Alternatives to Oxycodone

When the risks of taking oxycodone outweigh the benefits for a patient, a doctor might suggest alternate safe and effective ways to reduce or cope with chronic pain:

  • Non-opioid drugs such as acetaminophen or ibuprofen
  • Antidepressants and antiseizure medicines
  • Physical therapy and exercise
  • Behavioral therapy, which improves your coping abilities
  • Meditation and other relaxation techniques, which can alter your perception of pain and help you cope with it

Your Chronic Pain

Talk to your doctor about an appropriate choice of treatment of your chronic pain. Oxycodone is safe and effective when it is used for moderate to severe pain and it is taken as prescribed and stop when no longer needed.

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Oxycodone for Chronic Pain Management