Tag Archives: opioids

Opioid Cessation Prior to Surgery?

Does Opioid Cessation Prior to Surgery Help or Hurt? – April 4, 2017 By Thomas G. Ciccone

Patients receiving opioids prior to elective abdominal surgery had slightly longer hospital stays and were at higher risk of being discharged to a rehabilitation facility than opioid-naïve patients, according to the results of a new study.

“Chronic opioid use complicates management following surgery, and increases postoperative healthcare utilization and costs independent of other risk factors.”

None of these studies consider that opioids are prescribed for severe pain. Severe pain before surgery or unsuccessful surgery is what affects continuing opioid use.   Continue reading

New Opioid Drugs Promise Pain Relief, Not Side Effects

Next Gen Opioid Drugs Promise Pain Relief Without Side Effects – Health Rising – March 2016

Opioid based pain drugs have dominated the pain relief marketplace for years but their dominance has more reflected a lack of other options than anything else.

They’re quite effective at reducing acute pain but not so good at with chronic pain or with neuropathic pain.

They can produce a paradoxical hypersensitivity to pain and more mundane but still troublesome problems with constipation and itch.

Plus there’s the euphoria that abuse causes which can lead to addiction and a host of other problems.

Plus, patients responses to the drugs vary so widely that pain medicine has been called more of an art than a science.  Continue reading

3 Things You Need to Know About Opioid Pain Meds

3 Things You Need to Know About Opioid Pain Meds — Pain News Network 3/6/17 – By Janice Reynolds, RN, Guest Columnist

All medications have the potential to be dangerous, yet opioids are the only class of medication being treated as if they are the gateway to Armageddon.  Due to “fake news” and “alternative facts,” many see opioids as bad for acute pain, as well as persistent pain.

This hysteria has even affected the use of opioids to treat non-pain medical conditions — one being as a first line therapy for potential heart attack or heart failure. Opioids cause blood vessels to dilate and lower blood pressure; getting more oxygen to the heart, decreasing anxiety, and reducing the risk of a heart attack.   Continue reading

Opioids and bone density

The unsolved case of “bone-impairing analgesics”: the endocrine effects of opioids on bone metabolism – Ther Clin Risk Manag –  2015 Mar  – free full-text PMC article

The current literature describes the possible risks for bone fracture in chronic analgesics users.

There are three main hypotheses that could explain the increased risk of fracture associated with central analgesics, such as opioids:

1) the increased risk of falls caused by central nervous system effects, including sedation and dizziness;
2) reduced bone mass density caused by the direct opioid effect on osteoblasts; and
3) chronic opioid-induced hypogonadism

The impact of opioids varies by sex and among the type of opioid used (less, for example, for tapentadol and buprenorphine).  Continue reading

Dependence on Rx Opioids Confused with Addiction

Dependence on Prescription Opioids – Apr 2006 – Free full-text PMC article

This PubMed article describes “opioid dependence” as it is currently (and wrongly) defined in the ICD-10. This version of the standard diagnoses and billing manual has created a linear model of opioid “use disorder” (as though any use at all were a disorder).

This model relates the severity of the “disorder” to the frequency and amount of use, vilifies normal medication side-effects, and confuses symptoms of chronic pain with symptoms of opioid addiction.

It completely ignores the critical distinction between dependence and addiction, which results in a strange paradox:   Continue reading

Medicare Sets NO Maximum Opioid Dose

CMS finalizes 2018 payment and policy updates for Medicare Health and Drug Plans, and releases a Request for Information – 2017-04-03

The final policies are similar to those proposed and discussed in the Advance Notice and draft Call Letter in February but incorporate several changes in response to feedback received during the public comment period.

CMS apparently read our comments and reacted to them, unlike the CDC, which completely ignored input on their opioid prescribing guidelines.

This is the first national policy to give authority back to physicians to manage opioid medications for chronic pain patients. It could be a sign that the medical industry is finally reconsidering its rash generic restrictions on what should be a treatment plan developed by doctors with their patients.  Continue reading

Endorphins: Our Own ‘Natural Opioids’

The reason opioid medications work so well is that they mimic the structure and function of the opioids naturally produced by our own bodies.

This is also why I’m more comfortable with these medications than many of the other strange molecules designed to ease pain, like antiepileptics and antidepressants.

First, some basic definitions from Wikipedia:

Endorphins – Wikipedia

Endorphins (contracted from “endogenous morphine”[note 1]) are endogenous  opioid neuropeptides in humans and other animals.  Continue reading

Advice for Dealing With Difficult Patients

A Psychologist’s Advice for Dealing With Difficult Patients – March 2017

During his talk, Dr Mariano sought to address a common situation encountered by pain physicians in their every day practice: should they reinstate opioid treatment in patients successfully taken off these medications?

The answer is: it depends on the patient,

  • on whether they have a history of substance misuse,
  • on their functioning, and
  • whether they are actively involved in their own pain rehabilitation.

“This is the primary directive of opiate prescribing.

Yes, the primary directive of opioid prescribing is that it depends on the patient. That’s exactly why standard dose restrictions for opioids are not medically sound.
Continue reading

Opioids and the Treatment of Chronic Pain

Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions –  free full-text PMC article – Jul 2009

In most individuals, when opioids are taken to treat pain, there appears to be no overt effect from change in these systems. In some cases, however, powerful reinforcement occurs…

Opioids play a unique role in society. They are widely feared compounds, which are associated with abuse, addiction and the dire consequences of diversion; they are also essential medications, the most effective drugs for the relief of pain and suffering

This is a long post because the article contained so many gems of information (with references!).   Continue reading

Opioids + Pain != Euphoria

Psychoactive Properties of Opioids and the Experience of Pain –  Journal of Pain and Symptom Management – February 2016

Here is a letter to the editor of a pain journal from Stephen R. Connor, PhD of the Worldwide Hospice Palliative Care Alliance.  

He points out what so many of us have noticed: if you take opioids when you’re in pain, you do not get “high” (see also Opioids, Endorphins, and Euphoria)

A frequently held view in palliative care is that when patients in pain use opioids, they do not experience the psychoactive or euphoric effects of opioids.

Furthermore, that those not in pain who use opioids do experience these euphoric effects that may lead to opioid-use disorder.   Continue reading