Tag Archives: opioids

Tapentadol for Some Kinds of Severe Chronic Pain

Tapentadol Extended Release in the Treatment of Severe Chronic Low Back Pain and Osteoarthritis Pain – Pain Ther. Jun 2018 – free full-text /PMC5993688/

Tapentadol is a novel pain reliever with apparently synergistic dual mechanisms of action, capable of addressing both nociceptive and neuropathic components of chronic pain.

From Wikipedia: Tapentadol (brand names: Nucynta, Palexia and Tapal) is a centrally acting opioid analgesic of the benzenoid class with a dual mode of action as an agonist of the μ-opioid receptor and as a norepinephrine reuptake inhibitor (NRI). Analgesia occurs within 32 minutes of oral administration, and lasts for 4–6 hours

As an effective analgesic with good tolerability, tapentadol may be appropriate for patients suffering from severe chronic pain associated with low back pain (LBP) or osteoarthritis (OA).   Continue reading

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Cancer vs Noncancer Pain: Shed the Distinction

Cancer vs Noncancer Pain: Time to Shed the Distinction? – Charles E. Argoff, MD – July 23, 2013

What exactly is the difference between chronic cancer-related pain and chronic non-cancer-related pain?

None: NO DIFFERENCE between cancer and non-cancer pain

are we helping ourselves by making a clear dichotomy when the dichotomy may not exist in a chronic setting? Let’s talk about acute pain related to cancer.  Continue reading

Opioid Antagonists in Chronic Pain Management

A Fresh Look at Opioid Antagonists in Chronic Pain Management – October 16, 2017 – By Dmitry M. Arbuck, MD

The article explains how these drugs are *not* effective for the pain from physical damage but are able to reduce the pain from neurological “central pain sensitization”.

As clinicians reduce their reliance on opioids for the treatment of pain, they are turning to a wider array of pharmacological tools and approaches to help overcome deficiencies of opioids, such as treatment-limiting side effects, and as aids in relieving difficult-to-treat pain conditions.

One such approach is the use of opioid antagonists. The use of opioid antagonists—in particular, naltrexone and naloxone—in chronic pain management is not new, but it deserves more recognition and acceptance than it enjoys presently.   Continue reading

The MEDD myth: pseudoscience in guidelines

The MEDD myth: the impact of pseudoscience on pain research and prescribing-guideline development – free full-text /PMC4809343/ – J Pain Res – Mar 2016 – Jeffrey Fudin, Jacqueline Pratt Cleary, and Michael E Schatman

The authors point out that the concept of MEDD is flawed and call into question not only guidelines based thereon but also the many research studies that rely on such bogus numbers.

…the professional literature ubiquitously employs morphine-equivalent daily dose (MEDD) and other comparable acronyms to attribute escalating risks based on overall daily opioid dose.   Continue reading

Analysis of Pain Mgmt Tx from Cochrane Reviews

The user “Seshet” on the Inspire.com support forum has compiled this list of scientific evaluation of various non-opioid pain management treatments that are highly recommended by our government these days (as of June 2018):

An Analysis of Pain Management using Cochrane Reviews

The Cochrane organization (http://www.cochrane.org/about-us) provides meta-analyses and reviews of basic questions in clinical medicine.   Continue reading

Studies Show Addiction NOT Induced by Opioids for Pain

Introduction: Addiction and Brain Reward and Anti-Reward Pathways – free full-text article /PMC4549070/ – Aug 2011

This is a long and detailed article explaining at length how pain and addiction manifest in neurological processes in various areas of the brain.

It also contradicts the belief that opioids cause addiction, which has motivated the anti-opioid crusaders to make life a hell on earth for pain patients. (see Pain Patients Left to Suffer in ‘Hell on Earth)

Can One Induce Addiction
by Long-Term Treatment of Pain with Opiates? 
Continue reading

Hyperalgesia in Buprenorphine Maintenance Treatment

Pain Tolerance in Buprenorphine Maintenance Treatment – by Brandon May – April 13, 2018

Here’s an article showing the potential danger of this treatment, which results from buprenorphine binding more tightly to opioid receptors. Therefore it blocks more effective opioids while not relieving pain as well itself.

The actual study detailed in this article has a more bluntly honest title: Buprenorphine maintenance subjects are hyperalgesic and have no antinociceptive [pain relief] response to a very high morphine dose .

And from Wikipedia: “People on high-dose buprenorphine therapy may be unaffected by even large doses of opioids for episodes of acute pain. It is also difficult to achieve acute opioid analgesia in persons using buprenorphine for opioid replacement therapy.”    Continue reading

Iatrogenic opioid dependence or abuse <5%

Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta… : PubMed : NCBI – Br J Anaesth. 2018 Jun;

Here’s the latest study of the rate of drug abuse among people who are prescribed opioids. Besides establishing a less than 5% abuse rate, it found that high-dose long-term opioid users had lower rates of “abuse”.

This is exactly the opposite of the situation the CDC Guidelines intended to address by forcing low doses for short time periods only.

The primary objective of the current review was to estimate the incidence of iatrogenic opioid dependence or abuse after treatment with opioid analgesics.   Continue reading

Review and comparison of opioid therapy guidelines

Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines. – PubMed – NCBI – Pain Physician. 2014 Sep-Oct – Free full-text PDF article

Here is another study concluding that “There is a growing body of scientific evidence to support opioid use in chronic pain.”

OBJECTIVE:

To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence.   Continue reading

Study finds opioids ARE effective for chronic pain

Efficacy of opioids versus placebo in chronic pain: a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials – free full-text /PMC5939920/ – J Pain Res. May 2018

This most recent study contradicts all the hype saying that opioids aren’t effective for our chronic pain:

  • Opioids are efficacious in the treatment of chronic non-cancer pain for up to 3 months in randomized controlled trials”
  • Opioids … remain an important therapeutic option.”
  • I…the efficacy of opioids is at least as large as that of any other treatment for chronic pain.” 

Continue reading