Insufficient Evidence: How Opioid Deniers Spin Studies

Insufficient Evidence: How Opioid Deniers Spin Studies — Pain News Network – By Roger Chriss – April 2017

Researchers cannot and do not investigate if “opioids” work for “chronic pain.”

Good research is more narrowly focused, such as these clinical studies:

The results are equally specific.

In the first example above, the authors conclude that

“our results suggest that tapentadol ER, started at 100 mg/day, is effective and well tolerated in patients with moderate-to-severe chronic neck pain, including opioid-naïve subjects.”

Similarly precise statements are found in any such article.

Sometimes researchers will perform a meta-analysis or review in which they assemble a collection of existing research articles and, after a statistical analysis, attempt to draw broader conclusions. Examples include:

 

Opioid medications are coming under fire again as being ineffective for chronic pain management.

Charles Pattavina, MD, president of the Maine Medical Association, told the Portland Press Herald that “there is no clinical indication for opioid medication for the treatment of chronic pain.”

The last article above is often cited by opioid deniers, even though it concludes that “evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function.”

And Stanford psychiatrist Anna Lembke, MD, said in Vox that “if opioids worked long-term, I would have no problem with patients taking them.”

But sweeping generalizations like these oversimplify a complex situation.

Chronic pain is a highly heterogeneous feature of a wide variety of diseases and disorders.

And opioids are a broad class of pain medications that come in different doses and are administered by different routes.

Thus, a claim that opioids do not work for chronic pain is too simplistic.

“Evidence is insufficient” means that no determination can be made one way or the other about opioid medications. It does not prove that opioids are ineffective for chronic pain

This leads to the final defense of opioid deniers: Demand an impossibly high standard of evidence.

Specifically, they want the “gold standard” of clinical research: a double-blind, placebo-controlled, randomized trial of a specific drug for a particular condition.

To satisfy this standard, we would have to test every opioid medication against every medical condition causing chronic pain in a variety of different groups of people.

This would mean thousands of trials, each performed multiple times, before any meaningful conclusions could be drawn about opioid medications in general. The time and costs involved would be prohibitive in the extreme.

To be clear, opioid therapy can help manage a variety of forms of chronic pain. Not all pain, and not for all patients. And always under the care and guidance of medical professionals.

The goal of opioid therapy is to improve quality of life, and available evidence strongly supports that it does so.

Advertisements

2 thoughts on “Insufficient Evidence: How Opioid Deniers Spin Studies

  1. Emily Raven

    See, this is what I couldn’t articulate awhile ago when I said something rude in the direction of “evidence based” medicine. Half the time the evidence isn’t even for the particular condition. There’s like no studies for my EDS and specific comorbidities. Same goes for alot of “routine” conditions such as fibro, MS, pinched nerves from a permanent mechanical issue, etc. It’s just really silly sometimes what they try to tell you is undeniable fact. While usually interesting in itself, sadly it never applies to me.

    Liked by 1 person

    Reply
  2. Zyp Czyk Post author

    I agree. I felt like an aberrant freak with all my bizarre and changing symptoms and the ever-increasing pain until I was finally diagnosed with EDS at 54.

    The closer I look at medicine, the more I understand how it can only be effective if it’s individualized. Evidence only shows us possibilities and gives general guidance.

    Statistical “truths” only apply to populations, not individuals!

    Liked by 1 person

    Reply

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s