Narcotic (opioid) pain medication for chronic pelvic pain

Experts disagree about the use of narcotics (opioids), such as codeine, meperidine, morphine, oxycodone, or propoxyphene, for the treatment of severe chronic female pelvic pain.¹

Some experts think that the use of opioid pain medication should be avoided. They cite the muscle-relaxing effect of these medications, which may make some causes of pelvic pain worse. They also think that the sedating effects of opioids alter the normal thought process and further limit participation in daily activities. Some women with chronic pelvic pain also are at high risk for problems with substance abuse and addiction.

Other experts think that severe pain that does not respond to other medications should be treated with opioids. They think that brief use of opioids is generally well-tolerated and does not present a significant potential for abuse. These experts think that undertreatment of pain is more likely to lead to problems with chronic pain, drug abuse, and addiction. They think that early, aggressive, and time-limited treatment with an opioid is an effective method of treating pelvic pain.

Longer-term treatment with an opioid is sometimes used to treat severe chronic pain. If your health professional suggests this approach, discuss the risks, and consider getting a second opinion from a pain treatment specialist.

When given to treat unmanageable pelvic pain, an opioid is used on a regular schedule rather than on an "as needed" basis. Many health professionals require a signed, written contract for responsible use before prescribing an opioid.¹

Citations

1. Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594–611.