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.   

Pain control methods used by EDS patients

Pain control methods in use and perceived effectiveness by patients with Ehlers-Danlos syndrome: a descriptive study. – PubMed – Disabil Rehabil. 2016;

PURPOSE:
The purpose of this study was to assess the pain control methods in use by patients who have Ehlers-Danlos Syndrome (EDS), a group of connective tissue disorders, and their perceived effectiveness

METHOD:
This descriptive study involved 1179 adults diagnosed with EDS who completed an anonymous on-line survey. The survey consisted of

• demographics information, 
• the Patient Reported Outcomes Measurement Information System (PROMIS) Pain-Behavior,
• PROMIS Pain-Interference, and
• Neuro QOL Satisfaction with Social Roles and Activities scales, as well as a
• modified version of the Pain Management Strategies Survey.

Mortality After Discontinuation of Opioid Therapy for Pain

Mortality After Discontinuation of Primary Care-Based Chronic Opioid Therapy for Pain: a Retrospective Cohort Study. – PubMed – NCBI – J Gen Intern Med. – Aug 2019

BACKGROUND:

Despite known risks of using chronic opioid therapy (COT) for pain, the risks of discontinuation of COT are largely uncharacterized.

These “risks of discontinuation of COT” are not “largely uncharacterized” but rather completely unstudied.

Pain patients being tapered are being used as guinea pigs because those who are restricting opioids have no idea what the results might be. 

Management of chronic pain in EDS – part 2

Management of chronic pain in EDS – Nov  2018 – part 2

This post continues from the first part, with more detailed descriptions of various types of pain that arise from our tissue fragility and from consequences of related genetic changes.

3. Discussion

3.1 Chronic pain and EDS overview  (covered in previous post)

3.1.1 Musculoskeletal pain

Nociceptive, joint pain is usually the first manifestation of pain in EDS. 

Management of chronic pain in EDS – part 1

Management of chronic pain in Ehlers–Danlos syndrome: Two case reports and a review of the literature – journals.lww.com –  November 2018 – Part 1

I have a lot to say about this long article, so I’m going to break it into 3 separate posts:

Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis.

Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities.

Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals.  

List of Peer Reviewed Articles on Pain/Opioids

Peer-reviewed articles (2006-2019) on Pain/Opioids by Stefan Kertesz  (Twitter: @StefanKertesz)  June 2019

This is a collection of 26 scientifically correct (not anti-opioid) information that can be used as references to rebut the anti-opioid propaganda. Dr. Kertesz has been a powerful and respected advocate for us for many years and seems to be publishing voluminously.

Many of the articles below I’ve already posted, but here they are in a unified list of publications, most with links, which challenge the anti-opioid zealotry.  

HHS Report on Pain Management Finalized

Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations – May 30, 2019

Below is a link to the final version of the draft report:

The Comprehensive Addiction and Recovery Act of 2016 (CARA) required the Pain Management Best Practices Inter-Agency Task Force to develop the

Report on Pain Management Best Practices:
Updates, Gaps, Inconsistencies, and Recommendations,

which identified gaps or inconsistencies, and proposed updates to best practices and recommendations for pain management, including chronic and acute pain.

Background

• On December 31, 2018, the Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations was released for a 90-day public comment period (December 31, 2018 – April 1, 2019) in accordance with the CARA.  To view comments, visit the Federal eRulemaking Portal using docket number – HHS-OS-2018-0027.
• The Task Force approved the final report on May 9, 2019 by a majority vote.
• In accordance with the CARA, the final report is now available to the public, May 30, 2019, which is one year after the inaugural meeting.

Were Consequences of CDC Guideline Unintended?

CDC Opioid Prescribing Guideline: Unintended Consequences? – July 2018 – an angry essay by yours truly, Angelika Byczkowski (Zyp Czyk)

I’m sick and tired of reading over and over how all the entirely predictable consequences of the CDC Opioid Prescribing Guideline were “unintended” and “unforeseeable”.

The broad misinterpretation of the guideline as establishing fixed limits on opioid prescribing has stranded hundreds of thousands of pain patients in agony without the effective relief they had achieved with opioids.

Yet we are expected to believe that these consequences were “unintended” and “unforeseeable” by the guideline authors. Most pain patients realized right away that the guideline’s suggestions would become codified rules, no matter how little evidence supported them.

And we were right – more than we ever imagined… 

Brain abnormalities are Consequence Not Cause of pain

Brain Gray Matter Decrease in Chronic Pain Is the Consequence and Not the Cause of Pain | Journal of Neuroscience – Nov 2009

If you can reverse brain “damage” by effectively treating the patient’s chronic pain, it seems pretty clear that the chronic pain was the cause.

This means we don’t have to accept the idea that abnormalities in our brains are what’s causing our pain (which some have hinted at).

Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were reported in patients suffering from chronic pain.

Although some authors discussed these findings as damage or loss of brain gray matter, one of the key questions is whether these structural alterations in the cerebral pain-transmitting network precede or succeed the chronicity of pain.  

Pain Experts Call for End to Forced Opioid Tapering

International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering | Pain Medicine | Oxford Academic – 29 November 2018

We, the undersigned, stand as a unified community of stakeholders and key opinion leaders deeply concerned about forced opioid tapering in patients receiving long-term prescription opioid therapy for chronic pain.

This is a large-scale humanitarian issue.

As happy as I am to see this declaration, even long after the opioid prescribing guidelines were weaponized to force opioid tapers, I’m appalled that it took 2.5 years of entirely foreseeable consequences for all these doctors to finally speak up.

There’s an impressively long list of signatories to this document, including several that have been vocally pushing for the very restrictions they now call a “large-scale humanitarian issue”. I’m stunned at the hypocrisy.