When the Food and Drug Administration last week endorsed the CDC’s controversial guidelines to limit opioid prescribing, the agency promised it would prioritize development of non-opioid alternatives for chronic pain relief.
“The FDA has approved non-opioid medications for treatment of various chronic-pain syndromes, including
- gabapentin (Neurontin), (See Neurontin ‘Snake Oil’ Lawsuit Upheld)
- pregabalin (Lyrica), (See Lyrica Fails in Nerve Pain Study)
- milnacipran (Savella),
- duloxetine (Cymbalta), (See Warning: Cymbalta Discontinuation Syndrome)
and others, and a number of promising development programs are in the pipeline.
You can read about all the problems with these drugs in the other posts listed.
But we need more. The FDA will use all the tools at its disposal to move these alternatives along as expeditiously as possible, while remaining mindful that all medicines have risks.”
These days, any pain medication that is NOT an opioid is considered blessed, with little concern for its negative properties, yet it has been proven that these medications have far more side effects than opioids.
The four drugs mentioned by Califf all have mixed track records, and many chronic pain sufferers have told Pain News Network the medications either don’t relieve their pain or have intolerable side effects.
“Gaba (Neurontin) did nothing for me and Lyrica seemed to help a very little with nerve pain but it made me very shaky, as if I drank a gallon of coffee,” wrote Pam Cushion.
“The side effects of Cymbalta were more than I could bear. I got terrible pains in the skin on my upper back and shoulders, and it made me feel downright awful,” said Tracy W.
“As opiate medications are lowered, my Lyrica dosage has gone up. It does have side effects like weight gain and next day fogginess,” wrote Kenneth McKenna. “I look for physicians to use other medicines in a similar fashion, (due to of the opioid restrictions) which may turn out to be a worse problem than the opioids themselves.”
Both Lyrica and Neurontin are coming under scrutiny in the UK because of increasing reports that Neurontin and Lyrica are being abused to get high. Since 2012, over 60 overdose deaths in the UK have been linked to pregabalin and gabapentin.
Researchers in British Columbia also recently warned about the limitations of gabapentin, pregabalin, duloxetine, and venlafaxine (Effexor) when used to treat neuropathic pain.
“The best available evidence now indicates that as few as one in ten people can expect much pain relief from these drugs,”
“Many people who improve are getting a placebo effect, or would improve in time without any drug treatment.
Others end up
- with impaired thinking,
- balance disturbance,
- dry mouth, or
- other side effects that cause more harm than good.”
- The drugs may be ineffective for most patients, but Tejani says many doctors continue to prescribe them because of an exaggerated belief in their effectiveness.
“Increasing evidence suggests that drugs have relatively little useful role for most patients with chronic pain. We should be much more cautious about prescribing them, and warn patients about their side effects,”
“Whether an opioid is abuse deterrent or not hasn’t prevented tens of thousands of people who have had their wisdom teeth removed or experienced lower back pain from getting addicted to these painkillers. That is why the FDA must change its decision not to seek expert advice about the risks of addiction before it approves abuse-deterrent opioids.”
The comment section of this article points out how truly ineffective the non-opioid pain medications are, what awful side effects they have, and how only opioids are truly effective in and of themselves, while non-opioid treatments are only useful as adjuncts.
- Jane Babin
I have had both positive and negative experiences with alternative therapies for various conditions
I think it is terrfic that yoga works for you! But what if they told you ” ok now do yoga and we’ll stop the opioids”? That’s where I see this heading. I want my doctors to have all the best therapies available for me and everyone else and have the ability to choose from amongst them without making us fail alternative therapies first
in the case of opioids, it seems as though they are pushing the less effective therapies as first line
As in all medical decisions, I want it to be between me and my doctor about what is best for ME, not what someone else thinks is best, or is best for the world at large.
Even if the consideration is cost, I want to make that decision.
- Anne Fuqua
Patients like myself who have metabolic and/or malabsortive issues are frightened that a day will come when only abuse deterrent products are available. Doctors need a full array of weapons to treat chronic pain- both abuse deterrent AND conventionally designed medications.
- Janice Reynolds
I can’t help myself, but 11 million people use opioids without addition or problems. Many non-opioid medications are have dangerous adverse effects and even more are not paid for by insurance.
Many people are currently managing their pain well with opioids. Ignoring the needs of pain patients is ethically and morally wrong,
- Steve Ariens
I would suspect that getting empirical data from therapy treating a subjective disease is hard to get a firm conclusion on. I have yet to see any data that incorporates CYP450 status on chronic pain pts in regards if they are a normal/fast/ultra fast metabolizer.
- Jane Babin
At the forefront of gathering objective data for subjective diseases or symptoms like pain is funtional neuroimaging, using PET and fMRI scannin. This is your brain; this is your brain on pain; this is your brain on pain treated with drugs versus your brain on drugs for recreational purposes.
- Terri Anderson
The FDA dropped the ball when they issued the April 23, 2014 warning regarding the dangers of corticosteroids used to treat back pain. They could not bring themselves to mention the A word.
Now Dr. Forest Tennant claims that those of us who suffer arachnoiditis are no longer rare. Even Dr. Manchikanti (ASIPP) claims that arachnoiditis has been “missed by multiple governmental agencies.” This certainly includes the FDA.
- Another Warning: FDA Advisers Tackle Epidural Steroid Shots
- My Story: Disabled by an Epidural
- Update: Hidden Danger of Intraspinal Steroid Injections
After all, the Pfizer New Zealand Depo-medrol datasheet clearly states that this drug MUST NOT BE USED (epidural use) because it causes arachnoiditis. Also check out Pfizer Gelfoam used for surgical repairs which is another cause of arachnoiditis.
After I was injured, every physician that I consulted with pushed Lyrica and Neurontin/Gabapentin despite my complaints of memory loss and fatigue.
- Jane Babin
There is no adequately controlled, high quality data on long term opioid use. Period.Don’t take my word for it. This is the conclusion reached by the CDC, NIH, and IOM.So to say anything about it is simply opinion, conjecture and anectdote. That being said, I find it highly unlikely that you will find anyone who has ever taken opioids for any reason and has also practiced yoga to say that they are interchangeably efficacious.
- Dee Green
The CDC and Antiopioid lobby has specifically targeted opioids for exclusion from treatment that is already limited. So, yes the community is fearful that one form of treatment that helps them will ultimately be prohibited- it’s that simple.
- Richard Lawhern
Among people I’ve supported, quite a number have attempted so-called “alternative” therapies for chronic pain.
- physical therapy,
- Chiropractic (both cervical and general),
- fascia release therapy,
- Ayverdedic Medicine,
- Chinese herbal medicine,
- Vitamin B-12,
- Cognitive Behavior Therapy,
- Creative Visualization,
- TENS devices,
- magnetic and
- RF peripheral stimulation.
Among these techniques, the best characterization I can offer is that each appears to provide temporary relief for a few patients, and none can be reliably applied to all chronic pain patients with confidence of successful outcomes.
I have never seen reliable statistics on who succeeds with opioid therapy versus who gets into deep trouble; I only hear hundreds of individual stories
Thus my response to alternatives to opioid therapy is that they may be worth trying by some patients some of the time — but they are most definitely NOT consistently helpful. Success requires an uncommon investment of time, training and skill by physicians.
There is a desperate need for deeply funded and accelerated research into non-addictive medical treatment for chronic pain. And to the very best of my ability to determine from scanning medical literature, that research is simply not happening.
- Dee Green
Looking at the last CDC advisory concerning women of childbearing age and alcohol, it becomes even more apparent. Maybe I’m wrong but look at how they are attempting to “legislate morality”- we’ve been here before!
You would think that Congress would be investigating why an ideological based Antiopioid group has so much influence within the CDC and why the agency is using flawed statistics to justify their attempt to limit a medication that provides relief to a large group of patients who are ill, without including the patients who will be affected by any “guidelines” limiting treatment.
In my post, I show that the CDC’s report was a clear example of “pick and choose” statistics, making the overdose deaths look as overwhelming as possible, even though there are still fewer overdose deaths than many other accidental deaths:
It was a clear example of “pick and choose” statistics, making the overdose deaths look as overwhelming as possible, even though there are still fewer overdose deaths than many other accidental deaths:
what the CDC is attempting to do is outside of it’s purview– it’s within the purview of the FDA (remember the FDA didn’t approve PROPs petition in whole in 2012) after which the group approached the CDC and began stoking rage within the addiction community (family members dealing with the deaths of loved ones who were addicts- who were obviously looking for someone to blame- hence, blame the “pill”
- Pam Cushion
When there are millions of legitimate chronic intractable pain sufferers that ate having success using opiods, many of us have been on them for years with success, given a quality of life, our doctors have seen the difference it makes controlling our pain, and what is happening to us now that they have joined the addiction driven agenda in fear of the DEA, by lowering our meds to ineffective doses that leave us with zero quality of life, bedridden, no longer able to so simple tasks like laundry, showering, cooking a meal, family functions, enjoy what time we have with our kids, or totally stripping many of their medications throwing them into major withdrawal and death.
This opiodphobia brought on by the DEA, the CDC, who falsified the overdose death rate and are not being held accountable, are not being made to retract the deathrate, and why is that!? Because that FALSIFIED deathrate was made to fit the governments agenda, to hurt the ones who truly need these pain medications to relieve the never ending excruciating pain they exist in
Addicts have been around for decades, centuries even. They were looked down upon as the low class junkie and government wanted nothing to do with them. Now that they are being bought out by the rich, is only addiction being brought front and center. Us legitimate patients that depend on these medications are being given our death sentence
My body is physically, emotionally and mentally exhausted. I’ve had enough of therapies, injections, surgeries and most importantly playing medications roulette with drugs that don’t work but drain my pocket. I can foresee what’s going to happen now, I’ll be forced, thru no fault of my own, to go back to square one, a place I was at eight years ago, trying all kinds of meds that have awful side effects and do not touch the pain. I’m done trying alternative therapies. I’ve tried everything my body could take and I could afford. I cannot go thru that nightmare again.
Whatever time I have left, I just want to have a quality of life and get thru the day. I don’t want to go back to where I was years ago. My anxiety is thru the roof, and I keep getting more depressed as each day I read more and more articles about this hell