The Pre-Modern Approach to Pain Treatment

The March Toward a Pre-Modern Approach to the Treatment of Pain Continues, Undeterred by Science By Jeffrey A. SingerAug 2019

It seems that no amount of data-driven information can get policymakers to reconsider the hysteria-driven pain prescription policies they continue to put in place.

For all human beings, data is far less stimulating than hysteria. That’s why movements, like the anti-opioid zealotry, use scare tactics to motivate and mobilize the populace.

I can understand lay politicians and members of the press misconstruing addiction and dependency, but there is no excuse when doctors make that error.

I used to believe that doctors knew far more about my body and its functions than I did, but what I’ve seen during this “opioid” crisis has disabused me of that quaint notion. 

Yet National Public Radio reports that surgeons in 18 Upstate New York hospitals have agreed on an initiative to limit the amount of pain medicine they will prescribe to postoperative patients discharged from the hospital.

The reporter says that researchers “now know” that patients prescribed opioids for postoperative pain “can become addicted” and that “the new prescription guidelines can prevent this particular gateway to abuse.”

No, they cannot.

No number of guidelines or restrictions can “prevent” anyone from getting addicted.

Even without a single opioid, a person with certain genetic tendencies in certain environmental situations will become addicted to whatever drug is available.

One recent study published in the BMJ of more than 568,000 “opioid naïve” postsurgical patients followed for 8 years found a total “misuse” rate of 0.6 percent. (“Misuse” includes a range of non-prescribed drug use, from self-medicating with leftover pills to treat an ankle sprain on one extreme to addiction on the other.)

Broken down further, the researchers found the misuse rate was 0.15 percent in patients given just one prescription postoperatively and was 0.29 percent in patients who got a second prescription as a refill. 

Multiple highly-respected Cochranesystematic analyses, the most rigorous reviews in the medical science literature, found the addiction rate in chronic noncancer pain patients on long-term opioid therapy to be around 1 percent.

These numbers are absurdly low. Without the hysteria created by anti-opioid zealots, there would be little cause for concern and we’d be focusing on the root causes of the current “overdose crisis”.

We’re arguing about milligrams of dosages instead of working to solve the real problem, which lies in the current state of our economy and society.

Addiction and dependency/tolerance are two separate entities, but policymakers and many in the media equate the two. But the doctors in Upstate New York should know better.

in 2016, Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse explained,

Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities.”

Even though NIDA, the National Institute of Drug Abuse, is THE government agency for the study of and policies for drug abuse, this agency is one of the few that have been left out of any serious discussions.

In 2016 the Centers for Disease Control and Prevention published guidelines regarding opioid prescribing for pain. Many scholars and clinicians specializing in pain management and addiction treatment criticized the guide as lacking a basis in evidence

Complaints by academicians, clinicians, and the American Medical Association(Resolution 235) finally caused the CDC to issue a clarification in April 2019, noting, “Some policies, practices attributed to the Guideline are inconsistent with its recommendations.”

Zealots will always disregard information that does not suit their purposes, so policies will be interpreted as they prefer to interpret them, not as they were written.

Among the misapplications of the guidelines it noted were those that result in “hard limits or ‘cutting off’ opioids,” stating the “Guideline does not support abrupt tapering or sudden discontinuation of opioids.” 

Yet the statutory and regulatory restrictions remain unchanged.

And, once created and instituted, these restrictions will require considerable effort to remediate.

No matter how misguided and even perverse they are, we will be stuck with these morally corrupt restrictions long after they’ve been proven ineffective and even damaging.

To date 18 states have laws limiting the amount of opioids that can be prescribed for acute and chronic pain. Many have limits on the morphine milligram equivalent daily dose (MEDD) that may be prescribed, despite evidence in the peer-review science literature that MEDD is an inaccurate and inappropriate metric

So the march continues, undeterred by the facts, toward a pre-modern approach to the understanding and treatment of pain, and a pre-modern understanding of the risks and benefits of opioids, and the subtleties that differentiate dependency from addiction.

10 thoughts on “The Pre-Modern Approach to Pain Treatment

  1. Kathy C

    Don’t worry the American Psychological Association, is peddling a “solution.” https://www.apa.org/monitor/2019/09/patient-pain-management

    “Patient Centered” sounds innocuous enough, it is an over used catch phrase, the insurance industry came up with. https://www.apa.org/advocacy/substance-use/opioids/evans-opioids-testimony.pdf The APA is still deliberately conflating chronic pain with addiction. Since there is no requirement to track outcomes, in psychology research, not one of these researchers refers to any measurably effective pain treatment.

    None of these industry funded researchers ever researched how their misinformed statements, and deceptive marketing have added to the “crisis.”

    Liked by 1 person

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  2. canarensis

    “For all human beings, data is far less stimulating than hysteria…”
    Hey now, some data weenies are far more stimulated by facts than hysteria…unless you include volcanic anger at the hysterics –a form of stimulation after all. Anti-evidence hysteria certainly gets my BP up higher.

    This situation is beyond maddening & Kafkaesque for us science types.

    Liked by 4 people

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  3. louisva

    It is SO REFRESHING to know people that believe science,fact, and rational thinking. Think about it, science, if used properly, is self-correcting. As more facts are found they are added to what’s already known.

    Like

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    1. Zyp Czyk Post author

      Exactly. Science advances by proving previous ideas wrong, each time getting closer to the truth.

      Unless there’s money involved that requires the facts to match a desired belief, like “opioids are bad”’. Then it gets stuck endlessly reiterating the same mistake over and over and over… like all the studies about the horrors of some imagined dangerous number of milligrams of opioid.

      Liked by 1 person

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      1. louisva

        You said “Unless there’s money involved that requires the facts to match a desired belief, like “opioids are bad”’. Then it gets stuck endlessly reiterating the same mistake over and over and over… like all the studies about the horrors of some imagined dangerous number of milligrams of opioid.” Exactly what I meant when I said “if used properly.”

        Liked by 1 person

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  4. Kathy C

    I am trying to figure out where all of the apathy comes from. When the CDC issued the guidelines, not one of these self described experts, discussed any unintended consequences. As the touting of cutting the number of opioid prescriptions continues, the deaths are climbing. Not one of these “experts” said ‘Hey wait a minute, and did any math calculations. If as they claim x number of people were addicted, there was not any requirement for treatment or even evaluation. Anyone with half a brain would have known, that taking pain medications away from patients would have no effect on the number of addicted people. They created a bigger market for illegal drugs, since they had no route for treating the addicted.

    22 years later they are going after the opioid manufacturers for the deceptive marketing, avoiding the topic of unregulated health marketing, and the politicians who were complicit. They used this manufactured crisis, to mislead the public about healthcare, and peddle all kinds of pseudo science and nonsense. They are deliberately avoiding the epidemic of despair, and how money in politics undermined our public health. There are virtually no limitations on marketing, unlike most other developed nations. The CDC directs anyone to market their products as long as they have contain a “public health message.”

    Now they are going after the E Cigarette companies, for marketing to children, even though they used the CDC marketing guidelines. After all cigarettes are bad, so they could market their product to children as a wellness product. We are seeing the public health effects of that marketing, they introduced children to nicotine ( more addictive than heroin), and no federal agency was allowed to observe or restrict the marketing campaign. We no longer have any functional federal agencies to protect the public. They allowed anti vaxx ad campaigns, and no longer restrict any kind of marketing.

    Mass media is dependent on this ad revenue, so they will filter out any discussion of marketing or unenforced regulations. Most of the people profiting from this physicians, psychologists and even addiction specialists are all silent, unable to point out how some topics should be off limits to marketing, especially when there are public health consequences. After thousands of Americans died from patent medicines or were defrauded by quacks the US implemented restrictions on health related marketing. Now marketing has replaced fact based information. Patients are now “consumers” or “customers” not sick people, who are easily misled. Since the regulations are no longer enforced, anything goes, even when it has dire consequences. Advertisers are not required to list the bad outcomes, even though a vestige remains in the pharma advertisements on TV. Content marketers and in content, news articles have no requirement to be factual or enclose a disclaimer.

    Liked by 2 people

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