RSD / CRPS – Opiate and Narcotic Pain Medications and Their Risks

You live with pain every day because of your RSD or CRPS, and you just want to get relief from the hurting. You have heard about the effectiveness of medications like morphine and you wonder if these might help you gain some relief, even for a little while.

While narcotic pain medications and opiate medications can help some patients, for others, they don’t make a dent on the degree of pain they are experiencing. The medications in this class are most effective when used with other medications. Talk this issue over carefully with your doctor, because opiate and narcotic pain medications come with their own risks.


Opiates slow down your bodily functions including those of your digestive system and bowels. Medications such as morphine, fentanyl, oxycodone, vicodin and methadone can lead to constipation if you take them for more than a short time period. If you do choose to use opiate medications and you become constipated, this can lead to an impaction of your bowels which could require surgery to correct. (An impacted bowel is one that is full of accumulated feces that your body has not been able to excrete because of your constipation.) Your gastrointestinal system does not develop a tolerance to opioid medications, which means, if you develop constipation when you start taking the medication, it will not get better while you are prescribed the medication.


Opioid painkillers come with one very big caveat addiction. Because these drugs work on your brain’s pain receptors, they change how your brain perceives the pain you are feeling. One common opioid medication is oxycodone (generic name: Endocet).

Because of the risk of addiction, your doctor must supervise you very carefully as you take this medication. Your body becomes used to the dosage you are taking. When this happens, that dosage is no longer effective in controlling your brain’s reaction or perception of your pain. This means you require a higher dosage, and so the cycle goes. Eventually, you require much higher dosages over time.

Physical Side Effects

Opioid medications act on the emetic trigger zone this is the zone in your brain that triggers vomiting. All opioid medications come with this unpleasant and undesired side effect, according to the RSD Foundation website. Another side effect could be urinary retention, caused by the increased smooth muscle tone of your urinary pathways and of the sphincter in your bladder. This develops more frequently when your medication is delivered via intraspinal injection.

Central nervous system (CNS) effects can include confusion, dizziness, tiredness or fatigue, impaired ability to think and mood impairment. You can also develop slowed reaction time when you take an opioid medication. (Pain patients in Germany are not allowed to drive vehicles while on narcotic or opioid pain therapy.)

Unusual Side Effects

Some patients develop severe itching, which may be the effect of the opiate medication on the central nervous system. Again, this is more common when the medication is given via an epidural or intrathecal injection. Increased sweating can also develop. Seizures after using meperidine can develop.

Some patients experience involuntary myoclonic muscle contractions while others experience what is called opioid-induced muscle rigidity. Narcotic and opioid medications can affect the endocrine system. Young women can experience the stopping of their menstrual cycles or the production and flow of breast milk. Men can experience erectile dysfunction.

Rare Side Effects

Severe joint pains after the use of spinal opioid medications can, on rare occasions, develop. Why this happens is still not well-understood, but the cause is thought to be a suppressed cortisol release. A very small number of patients report that they develop increased pain sensations or pain to uncommon stimuli after taking larger narcotic doses for a long time.

Some patients develop analgesic asthma. Others develop a depressed ability to breathe (respiratory depression). Some patients might experience an accumulation of fluid in their lower extremities.

Some pain patients have developed hallucinations or psychotic symptoms when they took narcotic pain medications for their neuralgic pain conditions.

Some Thoughts

While some of these side effects are much more serious than others, you should remember that your doctor knows about the possibility of side effects and he will prescribe the lowest possible dose to control your pain. In addition, you can ask for a sustained-release or slow-release formulation rather than an immediate-release formulation. If you still experience severe side effects, you have the option of refusing further narcotic therapy. If the medications do reduce your pain, a rotation of opioid medications may make treatment easier for you. That is, your doctor will frequently change which opioid medication you take every so often.

Consequences of Exceeding Maximum Dosages

The maximum dosage of an opiate medication is the highest possible dose you can take without the risk of harm. If you do begin taking more than the maximum dosage, you can place yourself at risk of toxic side effects, which include kidney damage, stomach ulcers, liver damage, chemical imbalance, or death.

Poor Opioids

Some narcotic pain medications are not effective for chronic pain. These include Talwin and Demerol. Talwin has a ceiling effect beyond a maximum dose, it gives no additional pain relief. It can cause withdrawal symptoms. Demerol can put you at risk of seizures if you use it for more than a few days.

A Good Option

Tramadol is an opioid medication that is less likely to lead to some of the side effects caused by other opiate medications. It may be one of several medications used to treat your CRPS or RSD pain, according to the University of Iowa. If your doctor prescribes Tramadol, you are at lower risk of respiratory depression and constipation. Because it is a weaker opiate, you are also at decreased risk of dependency and abuse. Its most common side effects include dizziness, nausea, sedation, and occasional seizures. If you have a history of seizures, you should not use this medication; if you take SSRI or tricyclic medications, use caution if you are prescribed Tramadol.

For more information, you can view the American Chronic Pain Association’s website.

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References: The University of Iowa: Neuropathic Pain; Practical Pain Management: Medications for Chronic Pain;  RSD Foundation: Use of Opioids (Narcotics) to Treat RSD/CRPS; eMedicine Health: Chronic Pain