Every year, thousands of people start taking opioids to relieve pain. Many of them do not know that what begins as a temporary solution can end up being a chronic trap. They are not informed of the real risks of tolerance, dependence, withdrawal syndrome, or pain induced by the chronic use of the same drug. Is this possible?

At CAF Centres, we receive patients who have been consuming opioids for years without a clear explanation of what is really happening to them. Who should have warned them earlier?

How did we get here?

Opioids were originally developed for severe, acute, postoperative, or palliative situations. But over the last decades, their prescription has been trivialized. They have become a quick response to chronic pain, without addressing the real cause of the pain and without sufficient information about long-term risks.

It is true that there are responsible and aware doctors who properly inform their patients. But it is also true that many patients repeatedly state that no one warned them about the risk of dependence or induced pain. This reality has led many healthcare institutions, sensitized to the problem, to implement informed consent models before starting opioid treatments so that patients become aware of the real risks involved.

More opioids, more pain?

One of the lesser-known phenomena is opioid-induced hyperalgesia. The same drug that promised relief can end up making the nervous system more sensitive to pain. This is not just a paradox; it is a real risk that many patients suffer… without knowing it.

Moreover, quitting opioids is not easy. Professional medical support is necessary to do it safely. The withdrawal process can generate symptoms such as abstinence, anxiety, insomnia, agitation, increased pain perception, or even symptoms that mimic a worsening of the original pathology.

Many patients cannot differentiate whether what they feel is withdrawal or if the pain has really returned. And often, faced with confusion, they decide to continue with the drug… without exploring real alternatives.

When you don’t know you’re taking an opioid

Another worrying situation is that many patients are unaware that they are taking an opioid because it is part of a very common pharmaceutical combination, or because they are told it is a “weak” or “well-tolerated” drug.

In Spain, some of the most prescribed opioids in formats that can confuse are:

• Tramadol → Often presented as a moderate analgesic, but it is an opioid.
• Tramadol + Paracetamol (Zaldiar®, Ixprim®, among others)
• Codeine + Paracetamol (Efferalgan codeine®, Termalgin codeine®, Codoliprane®)
• Tramadol + Dexketoprofen (Enanplus®)
• Tramadol + Celecoxib (Velyntra®)
• Tapentadol (Palexia®, Palexia Retard®)
• Oxycodone (Oxicontin®, Targin®)
• Fentanyl (Durogesic®, Matrifen® — patches)
• Buprenorphine (Transtec®, Buvidal® — patches)

And now what?

At CAF, we advocate for a different model: detecting and treating structures responsible for pain, such as the superficial fascia, without chronifying the patient through medication. Fortunately, with the PMS Technique, we can relieve many chronic pains, improving patient functionality and often avoiding the need to resort to opioids.

It is not about demonizing or stigmatizing opioids but putting them in their proper place: a useful tool in specific situations, not a perpetual chain for those suffering chronic pain.

💬 Let’s open the debate:

• Is enough information given to patients before starting opioid treatment?
• Is it ethical to chronify a person with a drug that can worsen their pain?
• What real alternatives is the healthcare system offering these patients?
• Should informed consent always be signed before starting an opioid?