This is an essay I wrote out of sheer frustration
I’ve noticed a consistent error in the latest research on opioid therapy: All negative outcomes of opioid/pain research are attributed to the opioid medications instead of the underlying pain.
Researchers willfully ignore that opioids were originally prescribed for unbearable pain and proceeded as though the motivation for these medications were insignificant or irrelevant to their studies.
The many detrimental outcomes these studies find are exactly what you’d expect from a person suffering long-term chronic pain. But researchers place the blame for any negative outcomes on the opioid medications taken to relieve pain, not on the pre-existing pain itself.
That’s like stating that people who take Dilantin (antiepileptic) have seizures. Technically that’s correct, but it doesn’t address the reason people are using Dilantin in the first place, which is that they have epilepsy. This is the real source of their seizures, not the medication they take to control the seizures.
Yet this is exactly how recent studies evaluate opioid medication. They start by selecting a group of patients taking opioids and compare them to patients who don’t take them or take much less. Even if both groups have pain, they never consider varying levels of pain to be the legitimate reason for this disparity.
The particular study that made me question this type of design was the following:
“Patients on higher doses of opioids tend to have worse pain, worse function, and higher healthcare utilization when compared with patients on lower doses of opioids, according to a study designed to examine the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Results from this study were recently published in the Journal of Pain.” (http://www.clinicalpainadvisor.com/opioid-addiction/high-opioid-doses-lead-to-poor-outcomes-for-patients/article/633829/)
This can be rewritten and make more sense as: “Patients with higher levels of pain tend to have worse pain, worse function, and higher healthcare utilization when compared with patients with lower levels of pain.”
Those who take opioids generally have more serious or consistent pain than those that don’t or take less, so the comparison is actually between people with serious pain and people with slight or no pain.
Below is an example showing how such studies mislead.
A. Theoretical study on the detrimental effects of Dilantin:
- Study headline: People who take Dilantin have seizures
- Study reality: Dilantin is correlated with seizures (seizures are correlated with Dilantin)
- Media headline: Dilantin causes seizures
- Reality: People who have epilepsy have seizures
B. Actual study on the detrimental effects of opioid medication:
- Study headline: People who take opioids get depressed
- Study reality: Opioids are correlated with depression (depression is correlated with opioids)
- Media headline: Opioids cause depression
- Reality: People who have pain get depressed
This problem is evident in most of the recent studies of opioids. The researchers claim to be studying the effects of opioids when they are really studying the effects of chronic pain. They blame any and all negative outcomes, like depression or a sedentary lifestyle, on the opioids instead of proceeding to the root cause, which is pain.
How can we compare opioid therapy to non-opioid-therapy without accounting for the fact that people are taking opioids because of their otherwise unmanageable pain? Opioid dosages are determined by pain levels and a pain patient’s drug tolerance over time, so pain level and opioid dosage usually change in tandem.
However, pain patients are always warned that opioids will not remove all our pain, so many of us still have to cope with considerable, and sometimes disabling, amounts of pain and its damaging effect on our bodies and minds.
Yet these studies seem to be trying to link the opioid-reduced remains of our full pain to the opioids we take to relieve our pain. Nowhere mentioned is the fact that opioids are prescribed to treat the pain symptoms that they claim are caused by those very same opioids.
Many studies seem structured to support the currently popular (and funded) anti-opioid campaign. Simply by measuring opioid dosages instead of pain levels, such studies can produce the desired conclusions.
No other health conditions are studied like this, using the amount of medication rather than the severity of the condition as an indicator. It seems an almost deliberate deception to shift the cause of troubling symptoms from the pain itself to the medication we take to ease the pain.
Another example: In the 1970’s, a study came out claiming that oat bran reduced cholesterol. What was not taken into account is that people eating oat bran so long ago were also unusually health-conscious and active. That’s what was lowering their cholesterol, not eating oat bran.
Eating “health food” was only one of many obscure factors correlated with general good health (like owning running shoes, paying attention to weather reports, not watching TV, or knowing your pulse rate).
In science, such misbegotten studies are common before the underlying causes of the issue being studied are known (like knowing that bacterial infection causes ulcers, not the foods we eat), but this can hardly be said about opioids.
So, why are the negative consequences of opioid therapy being studied, but not the consequences of pain or the ability of opioids to ease it?
Pain has so much variety in its location, amount, and character that it can only be vaguely estimated from self-reports. Opioid dosages, on the other hand, can be controlled and measured. So, much like the drunk looking for his keys under a streetlight instead of where he lost them because that’s where he can see, researchers are designing studies that use opioid doses as though they were independent of pain levels because that’s what can be measured.
Chronic pain negatively impacts our health in so many ways that these studies are finding all kinds of ill effects. But all the studies are designed to attribute these detrimental effects to the opioids we take to relieve our pain instead of the chronic pain itself.
In this way, even medical science has been corrupted by anti-opioid bias due to the persistent cultural meme that “opioids cause addiction”, which has even come to be regarded as common knowledge.
In this way, even medical science has been corrupted by anti-opioid bias due to the persistent, though untrue, cultural meme that “opioids cause addiction”. This myth has been repeated so often that it has come to be regarded as common knowledge.
And that makes it the most effective propaganda of all.
A question for you, dear readers:
I’ve been scientifically inclined since childhood and believe there’s always a reason for how scientific studies are designed, but in this case, I’m flummoxed. I hope someone with a better understanding of current research protocols can explain away this apparent design flaw I’ve detailed – and restore my faith in the NIH and its research.
Note: A version of this essay was published as “Opioids Blamed for Consequences of Chronic Pain“ by National Pain Report – 2/23/2017