Though this long article is focused on the pain from Sickle Cell Disease, it applies equally well to other types of chronic pain.
Evidence of Benefits of Long-term Opioid Use
As almost everyone knows by now, a small group of physicians known as PROP (Physicians for Responsible Opioid Prescribing) have petitioned the FDA to restrict opioid labeling to 120 mg of morphine equivalents per day for only a 90-day duration. One of their major claims is that there is no “evidence” long-term opioid use is beneficial. To my surprise, one highlight of the meeting was a series of posters on the benefits of long-term opioid therapy. Purdue Pharma, LP, who admittedly has a vested interest in the topic, sponsored the studies, whichreviewed the world’s literature to find out if there is reported evidence that long-term opioid use is effective. Here is a review of their research:
In the first study, the research team, headed by Rayna Matsuno, reviewed published studies using Medline, EMBASE, BIOSIS Previews, and PubMed through October 2012.
The researchers found 55 reports of long-term opioid therapy among non-cancer chronic pain patients of greater than 6 months duration.* Ninety percent (90%) of the studies showed analgesia efficacy, and 88% of patients reduced their pain score by more than 25%. Analgesia effectiveness remained steady over the time course of the studies (majority of open-label studies [>75%] demonstrated a reduction in pain scores).
The investigators also reported that mental health of patients was universally unchanged or improved.
Most studies also showed improvements in function and quality of life. Physical health improvement was more varied, with most studies showing a modest improvement
Detrimental aspects of long-term opioid therapy were the utilization of more health and mental health services, endocrine abnormalities, and more depression and physical discomfort when compared to published norms. The researchers could not tell from the reports, however, whether the detrimental aspects were from opioids or the underlying pain condition.
In a related study, a research team led by Angela DeVeaugh-Geiss, also of Purdue, reviewed 43,519 patients started on extended-release (ER) oxycodone and 22,414 patients started on ER morphine for cancer (10%) and non-cancer pain.
By 6 months, 72% of patients on ER oxycodone and 81% on ER morphine had discontinued their opioid. Interestingly, if the patient remained on their opioid for more than 6 months, they likely continued for 18 months.
This information indicates that opioids are not used long term by most patients and that they must promote or allow some natural healing and resolution of a patient’s pain problem.
The stress caused by pain could inhibit healing, so that pain control can not only treat the symptom (pain), but the cause as well by allowing faster healing.
Moreover, conducting longer placebo-controlled, double-blind RCTs presents an unacceptable ethical challenge because suffering pain patients would receive a placebo.
Yet this is exactly what the DEA’s drug warriors (and even some doctors) are doing by taking away patients’ access to opioids
A symposium on the treatment of chronic pain in adults with sickle cell disease (SCD) illustrated the need to consider multiple different underlying pain mechanisms when treating individuals with chronic pain
At present, chronic pain in SCD is managed as if it was acute pain that simply lasted longer, with a heavy reliance on opioids and non-steroidal anti-inflammatory agents—reflecting the thought that the pain is caused primarily by inflammation. However, just as in the broader pain field, it is important to consider multiple different underlying mechanisms of pain [peripheral vaso-occlusive pain and central sensitization] and their potential antecedents in childhood, and to treat individuals accordingly,”
Approximately 50% of breast cancer patients reported having chronic neuropathic pain 3 years after their mastectomy, noted researchers from the State University of New York at Buffalo.4 This percentage decreases with time; however, a small percentage (19.5%) still had pain up to 10 years after surgery.
20% equals 1/5 of patients who probably don’t feel this is a small percentage. Again, the number of people suffering with pain is minimized by the researchers.
With greater than 200,000 new breast cancers diagnosed annually in the United States alone and mean survival at 15 years post-diagnosis approaching 90%, the national burden of morbidity from this often unrecognized but commonly occurring condition is staggering
Ceftriaxone Useful for Surgical Prophylaxis
Previous studies have shown that the drug, which activates the GLT-1 gene and enhances glutamate clearance, reduced both visceral and neuropathic pain in animals.