Are the simultaneous use of stimulants and opioids a superior combination for pain relief? History and science say yes....

History and science are pretty clear: the simultaneous use of stimulants and opioids have, for over a century, been reported to be a superior combination for pain relief. So what's up?

When I tell pain management physicians that ADD medications potentiate opioids, most just say ya they know, but they don't prescribe ADD medications.

It’s a puzzling situation. History and science are pretty clear: the simultaneous use of stimulants and opioids have, for over a century, been reported to be a superior combination for pain relief.¹ So, based on history, why isn’t every patient who’s taking opioids also taking a stimulant? 

For example, in 1977 the renowned analgesic researcher, William Forest, led a national cooperative study which clearly showed that a dose of dextroamphetamine with morphine increased morphine’s pain-relieving potency one and a half to two times.² Forest and colleagues posited that the great therapeutic benefit of the combination of dextroamphetamine and morphine wasn’t widely used because, “We suspect that the combination has not been accepted clinically at least, in part, because physicians do not want to subject their patients to the risk of abuse if these drugs (dextroamphetamine and morphine) are used.”

Status Report on Role of Stimulants in Chronic Pain Management

Stimulant administration in chronic pain patients may increase analgesia, improve mental and physical functions, and treat the comorbidities of fatigue, depression, daytime sedation, obesity, and attention deficit hyperactivity disorder (ADHD).

Regardless of terminology, stimulant or catecholaminergic compounds have an expanding role in pain management for a number of reasons. They have been shown to have innate analgesic properties, in addition to potentiating opioids, enhancing some mental and physiologic functions, and treating some common comorbidities of chronic pain, including fatigue, depression, daytime sedation, obesity, and attention deficit hyperactivity disorder (ADHD)

Why Intractable Pain Treatment Requires a Stimulant

Illicit Stimulant Use Common for Chronic Pain Management in Women With Neuropathic Pain

Roughly 35% of COPING participants reported illicit stimulant use in the past year; 37% of them used cocaine or crack cocaine, 31% had used methamphetamine (or speed), and 31% used both cocaine or crack cocaine and methamphetamine. Eight participants reported using prescription stimulants not prescribed to them, in addition to nonprescription stimulants during the study period.