The use of narcotic medication to treat body pain is a common practice for many physicians and other health care providers. Narcotics are effective at relieving many types of pain, and are safe if properly used. The use of narcotics to treat severe foot pain is a practice that still enjoys some popularity, primarily amongst non-foot specialists. Unfortunately, unlike pain in the rest of the body, foot pain often has a mechanical cause directly related to the way one’s foot structure functions when walking. The use of narcotic pain medication for foot pain will often lead to a worsening of the condition causing the pain. This article will discuss the nature of narcotic medication, foot pain, and how the two don’t necessarily work well together.
Narcotic pain medication is part of a large family of prescription drugs called opioids that effect the way people perceive pain sensation. These drugs typically bind themselves to cells from tissue found in the central nervous system and gastrointestinal system. The part of a cell an opioid binds to is called the opioid receptor. The medication binds itself to this area, and the end result of a complex process that follows is decreased pain sensation, increased pain tolerance, and euphoria. Unfortunately, some side effects can occur despite a good track record of safety when used properly. These can include sedation, a reduction in breathing ability, and constipation. Dependance on these drugs can also develop if they are taken long enough. When someone becomes addicted to pain medication, the dependancy effect as well the euphoria created by the drug reinforces the body’s desire to continue on the medication, even if it is not medically needed. By stopping the medication, a withdrawal effect can also develop, limiting the ability of an addict to discontinue the medication.
The traditional use of narcotic pain medication was for chronic, unrelenting pain. This type of pain is seen with terminal cancer, major surgery recovery, or during severe injuries like burns and major fractures. Recently, the use of narcotic pain medication has expanded to many types of pain, both acute and chronic. The masking of the pain can be beneficial for people to help restore a normal life without pain. This works fine if the pain is from an inflamed gallbladder, back arthritis, or rib fracture. When the source of pain comes from a foot injury, a more unique approach must be taken to control the pain, as simply ‘feeling better’ can often lead to a worsening of the injury that caused the foot pain and a delay in healing.
Most foot pain is due to an injury that occurs directly or indirectly as a result of some abnormality of the foot structure. For example, the vast majority of heel pain is due to an injury of a ligament in the arch called the plantar fascia. This injury is usually due to flat feet or high arches causing strain or shock, respectively, on the fascia. Without the abnormal foot arch structure, the heel would not hurt. The same can be said for many other common sources of foot pain, including Achilles tendonitis, arthritis, neuromas (pinched nerve), most toe pain, pain in the ball of the foot, bunion pain, and many causes of pain around the ankles. The common factor seen in these various conditions is the development of inflammation in the foot as a result of the body’s overzealous attempt to heal the injured tissue. The treatment for these conditions ideally needs to revolve around supporting the injured foot, restricting motion at the injured area, and reducing the overzealous inflammation the body creates during the healing process. By reducing the inflammation, the pain is reduced. With this and proper support, the body heals efficiently without excessive pain. Unfortunately, the use of narcotic pain medication only addresses pain control, and not inflammation or foot structure. Narcotics do not help at all with inflammation, which is the true source of most foot pain. These medications will only reduce the body’s perception of pain, allowing the inflammation process to continue. This will delay the body’s ability to heal the foot for two reasons. Firstly, the excess of inflammation not reduced by the narcotic medication will continue and the body will heal when it is good and ready. Often this time period will be for much longer than what is truly necessary, since the body forms an overzealous reaction to injury just to be on the ‘safe side’. Secondly, with narcotics, the tendency of many people is to resume activity as normal, since the foot does not hurt as much. When foot pain is correctly reduced because of inflammation reduction, increased activity may not be as harmful if proper foot support is still maintained. However, if foot pain is simply eliminated by a narcotic pain medication only, the feeling of ‘normal’ invites many into mistakenly resuming their activity as usual. This only worsens the foot injury and increases the inflammation, as the true nature of the injury is masked by the pain relief.
The foot is unique in that it receives the weight of the body above it and the stress of walking below it. Injuries to the foot need much more support and rest than any other part of the body. Narcotic pain medication use for foot pain allows excessive activity too early in the healing process, and should not be used for most types of foot pain as it does not address the underlying cause of foot pain: inflammation as a result of mechanically-caused injury. There are times in which narcotic pain medication is acceptable, and even advised for foot pain. Severe crushing injuries, fractures, burns, and other injuries that have nothing to do with foot structure or normal inflammation can benefit from pain control. However, narcotic pain control in fractures should be short term, and strict control of motion and activity is necessary, even if the foot ‘feels better’ with pain control. Foot pain from surgery can also be treated with narcotic pain medication in the short term, as much of that pain is due to the cutting of tissue. Most people require only a brief period of pain control following foot or ankle surgery, which does not usually exceed 3 weeks in most cases.
Narcotic pain medication has its place in the treatment of pain in the body. When dealing with most causes of foot pain, the combination of a likelihood of worsening the foot injury, delaying healing, and the problems of narcotic addiction make the use of these powerful drugs ill-advised. Properly addressing the inflammation of the injury, supporting the foot, and dealing with the abnormal foot structure that likely led to the painful condition in the first place are far better ways to treat foot and ankle pain.
Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website for more information.