Effect of chronic opioid therapy on pain and survival

UMN researchers study effect of chronic opioid therapy on pain and survival in sickle cell disease | EurekAlert! Science News Apr 2019

Though this article is specifically about Sickle Cell Disease, it can be applied to many other kinds of chronic pain.

New UMN research recently published Blood Advances, Kalpna Gupta, PhD, Professor of Medicine, University of Minnesota Medical School, demonstrates the impact of opioids on the survival of humanized mouse models with sickle cell disease, compared to normal mice.

Sickle Cell Disease (SCD) affects millions of people throughout the world. The genetic disease worsens over time and can cause lifelong pain.

Given the often severe nature of the pain associated with SCD opioid use is a rule not an exception for treatment.   

The mice in this study showed characteristics of pain observed in patients with Sickle Cell Disease (SCD).

“We wanted to know if opioids reduce survival,” said Gupta.

“There was a distinct difference in survival with morphine treatment between control mice expressing normal human hemoglobin and sickle mice expressing human sickle hemoglobin.”

Patients with SCD have reduced survival. Since many use opioids long-term, it is critical to know if opioids reduce survival in SCD and if they are really required. 

Who gets to decide whether opioids are “really” required?

“Our findings show that opioids cause hyperalgesia, which means they do cause pain, and that is why there is an increased requirement of morphine as the time goes by, it may not be due to the reward function.

What? This supposedly educated researcher seems to be mixing up hyperalgesia and tolerance.

If opioids were causing hyperalgesia, then any increase in the dose would only cause more pain, while “an increased requirement for morphine” is virtually the definition of tolerance.

Another option unmentioned and apparently unconsidered is that “an increased requirement for morphine” can be due to the painful condition worsening. I never see that mentioned in all the studies on opioids these days.

This study provides evidence for the first time that

  1. opioid requirement in SCD may be genuine and
  2. is not causing an adverse effect on survival and
  3. that even after long-term use opioids continue to remain effective in treating pain.

All 3 of these points are significant:

#1 I find extremely insulting to all patients reporting severe pain to their doctors. Apparently, they don’t believe it’s genuine until a scientific study proves it. Luckily, for SCD patients, they now have proof that their reported pain is “genuine”.

#2 is a no-brainer and makes me wonder why they believed opioids would lessen survival when they are used correctly. In fact, pain relief extends life because it prevents the continuous harm inflicted by chronic pain. There have been no reports of deaths related to opioids when they weren’t used in an overdose.

#3 tells the scientific community that there *is* proof that opioids continue being effective even in long term use.

According to Gupta, it would be critical to perform observational analysis on SCD patients receiving opioids to validate these findings, so that their pain can be managed effectively without opioidphobia amongst the providers.

Until alternatives to opioids are found,
pain needs to be treated with opioids.

This is the truth completely ignored in the zeal of the literally misguided “fight” against the overdose crisis. Thanks to PROP and friends, the public has been deliberately misled to believe the deaths are caused by our opioid prescriptions.

However, this study in humanized sickle mice also highlights the unmet need to develop effective analgesics to treat pain in SCD and in many other conditions.

But there are already “effective analgesics to treat pain in SCD and in many other conditions” – they are opioids. Researchers have become so brainwashed that they actually forget that opioids have always been safe and effective for over 95% of patients.

3 thoughts on “Effect of chronic opioid therapy on pain and survival

  1. canarensis

    “However, this study in humanized sickle mice also highlights the unmet need to develop effective analgesics to treat pain in SCD and in many other conditions.”

    That line made me want to scream. It’ll be decades –or forever– before a truly effective & safe non-opioid pain reliever hits the market. I suppose 96% of CPPs & over 99% of acute pain patients will just have to live out their (our) lives in untreated agony.
    That line made me want to scream. It’ll be decades –or forever– before a truly effective & safe non-opioid pain reliever hits the market. I suppose 96% of CPPs & over 99% of acute pain patients will just have to live out their (our) lives in untreated agony.

    Were you able to see the original paper? I’d really be curious what kind of data shows opioids cause hyperalgesia though it may well be as you said, & they were confusing tolerance with hyperalgesia.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Can’t get the full article – and I’m pretty sure that in the context of his statement, the word “tolerance” is what he meant. People thrown around “hyperalgesia” a lot without understanding what it means and how it’s different from “allodynia”.

      From Wikipedia: “Allodynia refers to central pain sensitization (increased response of neurons) following normally non-painful, often repetitive, stimulation. Allodynia can lead to the triggering of a pain response from stimuli which do not normally provoke pain.”

      Liked by 1 person

      Reply
      1. canarensis

        Oho. I’ve heard “hyperalgesia” so often in the “opioids actually increase your pain” context that I’d come to believe that was the only definition of the word. Apparently my docs don’t get it either…not surprised, they’re mostly swallowing the propaganda whole.

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