Category Archives: Pain Management

Increased or improved pain after opioid taper?

Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review – December 2018

This review (based on low-quality evidence) came to the unlikely conclusion that their hypothesis is true: pain doesn’t increase (and sometimes even decreases) when opioids are tapered.

Considering that people are committing suicide due to pain when their opioids are tapered, this study’s findings fly in the face of reality. But people (and our doctors) who read such “research” papers then end up believing this heavily biased nonsense.

Objective

To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.  

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Alternatives to Opioids in Medication for Pain

Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials – free full-text /PMC5785237/ – 2018 Nov

This recent review finds that there is very little evidence beyond a few weeks for the “effectiveness” [see qualification at end of review] of any non-opioid medication that has some beneficial effect on pain.

The goal of this review was to report the current body of evidence-based medicine gained from

  • prospective,
  • randomized-controlled,
  • blinded studies

on the use of non-opioid analgesics for the most common non-cancer chronic pain conditions.    Continue reading

Diagnosing Hyperalgesia to Limit Care

Misuse of Hyperalgesia to Limit Care | Practical Pain Mgmt | By Donald C. Harper, MD, BSc March 2011

John (not his real name) is a 51-year-old chronic pain patient that I have been seeing since 2003. I had begun carefully titrating him on oxycodone, Oxycontin® and Dilaudid®, which had been started by another doctor and, ultimately, settled on a dose of Oxycontin 640mg B.I.D., 32mg hydromorphone q 4 hrs prn breakthrough pain and Xanax® 1 to 1.5mg q.i.d. prn muscle spasms and anxiety. On these medicines, he was content and functional and denied any deficits or side-effects due to his medicine.

His insurance company was concerned about the expenses of his medicine and asked me to arrange for a second opinion. Given the complicating factor of his end-stage lung cancer, I arranged for an evaluation by the pain clinic of a major cancer center.   Continue reading

Opioid Prescribing Limits for Acute Pain

Opioid Prescribing Limits for Acute PainJAMA – Jan 2019

Recent studies indicate that the amount of opioid medication prescribed for acute pain often exceeds the amount of opioid actually consumed by patients

as of November 2018, a total of 32 states have enacted legislation that limits the duration of opioid prescriptions to patients with acute pain or to patients new to opioids, in most cases to a 7-day supply or less.

Here’s another push to standardize (and make cheaper) our medical care. The designers of this nonsense disregard all individual variation and create arbitrary standards for medical pain management.

I don’t understand why they are allowed to create policies that oppose the neuroscientific facts and force doctors to follow them.  Continue reading

Different opioids, different consequences

Members of the same pharmacological family are not alike: Different opioids, different consequences, hope for the opioid crisis? – ScienceDirect – Feb 2019

This paper demolishes the concept of standard conversions of different opioids to some universal MME (Morphine Milligram Equivalent) dose for all patients. Any such standardization of pain management is not based on science or medicine, but rather wishful anti-opioid thinking.

Highlights

  • This review highlights the wide-ranging drug-specific differences among opioids.
  • This includes differences in pharmacology as well as receptor and ligand biases.
  • Opioids also differ in their interactions with the immune and dopaminergic systems.
  • Elucidation of these differences will aid in developing novel opioid analgesics.
  • It could also aid in tailoring use of existing opioid drugs for precision medicine.   Continue reading

Oxytocin – A Multifunctional Analgesic

Oxytocin – A Multifunctional Analgesic for Chronic Deep Tissue Pain – free full-text /PMC4276444/ – Jan 2015

Abstract

The treatment of chronic pain arising from deep tissues is currently inadequate and there is need for new pharmacological agents to provide analgesia

The endogenous paracrine hormone/neurotransmitter oxytocin is intimately involved in the modulation of multiple physiological and psychological functions. Recent experiments have given clear evidence for a role of oxytocin in the modulation of nociception.

The present article reviews the existent human and basic science data related to the direct and indirect effects of oxytocin on pain   Continue reading

Pain Processing: Examining the Role of Oxytocin

Pain Processing: Examining the Role of Oxytocin – Rodriguez, MA, LPC – Nov 2017

This is a brief, but technical article about how oxytocin might be useful for chronic pain. While it doesn’t do anything for nociception, it seems to alter the sensation of pain by reducing the part that makes it “hurt like…” not just “feel like…”.

The role of oxytocin (OT) in pain perception has been extensively studied, mainly in animal models; however, a limited number of studies have examined the analgesic effects of OT in humans.

A review recently published in Neuroscience explores the evidence and findings that have uncovered OT sites of action along pain processing pathways.  
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Current Status of Anti-Nerve Growth Factor for Pain

Current Status of Nerve Growth Factor Antibodies for the Treatment of Osteoarthritis Pain – free full-text /PMC6007861/ – Jun 2018

Blockade of nerve growth factor (NGF) with antibodies is a promising strategy for treatment of chronic pain associated with osteoarthritis (OA).

Promising according to who?

all reported trials have been funded by the pharmaceutical industry and there are no independently funded trials listed in http://www.clinicaltrials.gov nor are there independent data.

This is the conundrum of drug development. Only those who stand to profit will pay for the expensive research and trials, yet those are exactly the entities most motivated to use “gamed” statistics and produce biased results.   Continue reading

Anti-Nerve Growth Factor for Pain: Jan 2018

NERVE GROWTH FACTOR (NGF) BLOCKADE FOR THE MANAGEMENT OF OSTEOARTHRITIS PAIN: WHAT CAN WE LEARN FROM CLINICAL TRIALS AND PRECLINICAL MODELS? – free full-text /PMC5436144/ – Jan 2018

This article shows both the successes and problems with using anti-NGF drugs to control pain when we’re not exactly sure of all the other effects such a drug might have.

Purpose of review

Anti-NGF antibodies hold tremendous potential for the management of osteoarthritis (OA) pain, but clinical trials have revealed serious adverse effects that are incompletely understood.

This review discusses clinical trial results along with preclinical studies that have assessed NGF blockade in experimental OA, in order to provide insight for future studies.   Continue reading

Why California pharmacies are rejecting some opioid Rx

Why California pharmacies are rejecting some prescriptions for pain medications – BY CATHIE ANDERSON – Jan 17, 2019

Doctors around California are complaining that the state did not send them notice of a Jan. 1 change in prescription forms and that pharmacies are rejecting prescriptions for controlled substances on forms they used just last year.

Dr. Richard Buss, a family practice physician in Jackson, said this is the second year the state made changes to prescription requirements without notifying doctors directly.

He said he was unaware of the change until Jan. 2 when a pharmacy told him it wouldn’t fill a prescription. He was unable to get new prescription forms that meet state requirements until Monday.

Just another problem created by the cumbersome bureaucracy built up around opioids, creating mess after mess after mess… and never being held accountable for any damage.   Continue reading