No reason to abandon opioids for chronic pain

Opioids for Legitimate Pain Patients, Their Needs Matter Too. – The Recover – By Shannon Werner – July 16, 2018

Finally, an article promoting opioid use where it is needed from a very unlikely source (therecover.com) and citing a review of 15 research studies that found opioids effective.

Addiction is rampant and crackdowns from the doctors limiting their prescription amounts, States are limiting the length of time patients can receive a prescription for and Medication manufacturers are even laying off their salesman with the increasing number of lawsuits they are facing every days.

So how are legitimate pain patients supposed to manage their extreme chronic discomfort within the confines of the opioid crisis limitations?  

Endometriosis, fibromyalgia, arthritis, cancer, and countless other intensely painful conditions that leave the person in constant forms of pain are treated like common junkies when they ask their doctor for the medications that have been shown to work best for their current cases.

Of course the FDA asks patients to seek other viable alternatives to treat their pain, but many say the alternatives don’t work.

At last week’s open Food and Drug Administration hearing on chronic pain… 

• Over 90% of the patients at the FDA meeting and watching online said they had tried using the suggested NSAIDs.
• More than 80% said they had used opioids to control their pain.
• And 77% said they had used gabapentin (Neurontin) or pregabalin (Lyrica), both anticonvulsant drugs also approved to treat pain.
• 68% said they had tried dietary supplements and herbal remedies to treat their pain,
• 47% had tried cannabis, either medical marijuana or other derivatives of the plant.
• 68% used acupuncture or massage therapy and another
• 47% tried counseling or psychological treatment.

But their insurance provider does not cover most of those treatments.

the CDC says, patients may have to change their expectations about living with pain. Even suggesting that studies backed by anti-opioid activists showed “opioids are ineffective or can worsen both the pain and the long-term outcome.”

And the CDC’s opioid prescribing guideline tells us there is “insufficient evidence to determine long-term benefits of opioid therapy for chronic pain.”

But new studies are going against that recommendation, saying opioids are effective and the evidence was there all along.

This is truly absurd. Is this perhaps the evidence that the guideline writers managed to exclude by imposing very unusual conditions on the studies they selected?

Researchers at Brown University and Tufts University School of Medicine analyzed 15 clinical studies performed for the Food and Drug Administration that looked at the effectiveness of opioids in treating chronic non-cancer pain.

Their findings were just published in the Journal of Pain Research.

I cannot find a reference to this analysis yet.

The 15 placebo controlled studies were to show that pain management for chronic pain sufferers is not a lost cause, and some people should be allowed the use of opioid medications.

Hydrocodone, Oxycodone and Tramadol along with other opioids were evaluated on their effectiveness for 3 months to show “an accurate assessment of their benefits.”

“There is an ample evidence base supporting the efficacy of opioid analgesics for at least 3 months’ duration,” lead author Nathaniel Katz, MD, president of Analgesic Solutions and a professor of anesthesia at Tufts University wrote. “This evidence base is at least as large as that for any other class of analgesics, and analysis of responders demonstrates clinically meaningful improvements.”

Almost 2/3rds (63%) of the patients who participated in the 15 studies showed a “clinically meaningful response” to opioids as a treatment for chronic pain. Their physical function only improved marginally, and researchers say there was no positive or negative effect on the patients’ mood.

Interestingly, adverse effects were similar in the patients who took opioids and those who were given placebos.

In short,

the authors found no reason
to abandon opioids
as a treatment for chronic pain.

“While the effectiveness of existing treatments for chronic pain leaves plenty of room for improvement, and considering that only a small minority of patients do not experience clinically meaningful treatment response,

I’d like to know why we are hearing the opposite from the anti-opioid campaign.

discarding all analgesics approved for chronic pain contradicts numerous treatment guidelines, international treatment guidelines, widespread patients experience, and the FDA approval process,” they wrote.

At least one guideline author has already denounced the opioid restrictions being ruled and legislated as a result of their work.

They point out (futilely) that the guidelines stated individual patient characteristics should be considered and that it only applied to new patients and for general practitioners, factors being completely ignored by bureaucrats and legislators.

These types of studies are necessary for patients who are unable to use other forms of pain management treatments to quell their discomfort.

Not everyone who uses the medication becomes addicted or abuses their pills.

Genuine chronic pain sufferers should be treated on a case-by-case basis to ensure accurate treatment and allow those to have a chance at a normal life, not confined to a life of constant agony because of the people before them.