Tag Archives: opioids

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.  

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 Use, Misuse, and Suicidal Behaviors

Opioid Use, Misuse, and Suicidal Behaviors in a Nationally Representative Sample of U.S. Adults. – PubMed – NCBI – just the abstract available – Mar 2019

This study proves that simply using opioids to treat a medical condition does not lead to increases in suicidal thoughts and behaviors.

Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known.

We assessed associations between opioid use and misuse to suicidal ideation, suicide plans, and suicide attempts among adults 18-64 years old (n=86,186) using nationally representative cross-sectional data from the 2015-2016 National Survey on Drug Use and Health.   Continue reading

Low rates of dependence/addiction from opioids for pain relief

I edited the title because it’s been pointed out that “dependence” isn’t the right word. I knew this but was paraphrasing the article title, which uses that word instead of addiction, even though they are clearly talking about opioid misuse. We can thank the DSM-5 for this confusion.

Development of dependence following treatment with opioid analgesics for pain relief: a systematic view – June 2012

Aims: To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.

Spoiler alert from the happy conclusion:

The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence.    Continue reading

California’s probe of opioid deaths

Doctors call California’s probe of opioid deaths a ‘witch hunt’by Cheryl Clark – Jan 2019

The Medical Board of California has launched investigations into doctors who prescribed opioids to patients who suffered fatal overdoses, in some cases months or even years later.

The effort, dubbed “the Death Certificate Project,” has angered physicians in California and beyond, in part because the doctors being investigated did not necessarily write the prescriptions that led to a death.

That makes it the most comprehensive [and perverse] project of its kind in the country.   Continue reading

Impact of High-Dose Opioids on Overdoses

Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality | Pain Medicine | Oxford AcademicJanuary 2016

Objective.

Previous studies examining opioid dose and overdose risk provide limited granularity by milligram strength and instead rely on thresholds.

We quantify dose-dependent overdose.

Spoiler: there is no linear or incremental increase in overdose risk by dosage.  The 90MME limit proposed by the CDC Guideline isn’t based on science, but more like a consensus “best guess” by addiction doctors.  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

Switching Opioids for Better Pain Relief

Could Switching Opioids in Cancer Patients Provide Relief? – Lori Smith, BSN, MSN, CRNP – Nov 12, 2018

I’m disappointed to see this limited only to cancer patients. Since we know that there’s NO DIFFERENCE between cancer and non-cancer pain, these findings would also apply to other kinds of chronic pain.

Side effects and inadequate pain relief with the use of opioids in cancer patients is a challenge for healthcare providers to manage and can cause considerable problems for these patients.

While the topic is still debated within the medical community, opioid switching in cancer patients may provide relief of pain and alleviation of opioid-related side effects, according to the results of a recent Italian study.   Continue reading

SSRIs Inhibit Effectiveness of Common Opioid

Common opioids less effective for patients on SSRI antidepressants, study finds – February 6, 2019 by Stanford University Medical Center

I’m reposting this because I accidentally scheduled it for a date before it even existed, so here it is if you missed it the first time around:

Patients taking the most common form of antidepressant who are given the most widely prescribed opioid experience less pain relief, Stanford University School of Medicine investigators have discovered. As many as 1 in 6 Americans takes antidepressants, mostly selective serotonin reuptake inhibitors.

Stanford researchers found that SSRIs reduce the effectiveness of hydrocodone and codeine, which are often prescribed to patients who have recently undergone surgery.   Continue reading