In the face of an ever-worsening opioid crisis, physicians concerned about fueling the epidemic are increasingly heeding warnings and feeling pressured to constrain prescribing in the name of public health.
As they do so, abruptly ending treatment regimens on which many chronic pain patients have come to rely, they end up leaving some patients in agonizing pain or worse.
Last month, one of us was contacted by a 66-year old orthopedic surgeon in Northern California, desperate to find a doctor for herself. Since her early 30s, Dr. R suffered from an excruciating condition called Interstitial Cystitis (IC). Continue reading
Justification of Morphine Equivalent Opioid Dosage Above 90 mg – Practical Pain Management – August 16, 2017
It is recognized that some patients with severe chronic pain require opioid dosages over 90 morphine milligram equivalents (MME) a day.
The Centers for Disease Control and Prevention (CDC) has stated in its opioid prescribing guidelines that physicians should evaluate and carefully justify the rationale for prescribing above this level.
In California, where we practice, also has written guidelines that require justification for a daily opioid dosage above 80 MME. Continue reading
Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects – 2006 May – free full-text PMC1459894
This meta-analysis was carried out with these objectives:
- to compare the efficacy of opioids for CNCP with other drugs and placebo;
- to identify types of CNCP that respond better to opioids; and
- to determine the most common side effects of opioids. Continue reading
Survey Elucidates Chronic Pain Patient, Household Member Perceptions of Long-Term Opioid Therapy – Pain Medicine News – July 2017 – by David C. Holzman
The vast majority of patients on long-term opioids who began therapy after surgery, an accident or an injury believe that the drugs reduce their pain at least somewhat.
And more than half said they do so very effectively, according to a joint survey by the Kaiser Family Foundation and The Washington Post
- 57% said their quality of life is better than it would have been without opioids, but
- 24% said it’s worse. Continue reading
Opioids in chronic noncancer pain: More faces from the crowd | Pain Res Manag | Jul-Aug 2012 | C Peter N Watson, MD FRCPC | free full-text PMC3411376
The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years.
Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability.
Problematic use, tolerance and serious adverse effects, including constipation, were not major issues. Continue reading
Will Strict Limits on Opioid Prescription Duration Prevent Addiction? Advocating for Evidence-Based Policymaking – Mallika L. Mundkur , MD, MPH, Adam J. Gordon , MD, MPH & Stefan G. Kertesz , MD, MSc – June 20, 2017
In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.
The guideline included the recommendation that patients treated for acute pain should receive opioids for no longer than 7 days, prompting at least five states to implement laws requiring prescribers not to exceed this threshold when providing initial opioid supplies.
The rapid conversion of this guideline into policy appears to reflect an underlying assumption that limiting initial opioid supplies will reduce opioid consumption, and thus addiction. Continue reading
On Thursday, June 8, the U.S. Food and Drug Administration “requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated Opana ER (oxymorphone hydrochloride), from the market,” the FDA said in a statement.
Apparently Opana ER, an extended release form of the opioid drug oxymorphone, was being crushed up and injected by people seeking to abuse it.
“After careful consideration, the agency is seeking removal based on its concern that the benefits of the drug may no longer outweigh its risks. This is the first time the agency has taken steps to remove a currently marketed opioid pain medication from sale due to the public health consequences of abuse.” Continue reading
Improving the analgesic effectiveness of opioids while also reducing the adverse effects is a major goal of pain research.
One approach to this problem has been to combine drugs such as cannabinoids with opioids to determine if this might reduce the dose of opioid required to produce analgesia.
In this experiment, male nonhuman primates (rhesus macaques) were administered a range of doses of THC in combination with cumulative doses of heroin to determine if the combinations produced greater analgesia than that observed with heroin alone.
Briefly, the animals were secured in standard primate ch airs, tails were shaved, and dipped in a mixed order in three different water temperatures (40 °, 50 °, and 55 °C) until the animal rapidly withdrew his tail, or 20 seconds elapsed. Continue reading
Effective Opioids Declared Ineffective – by Zyp Czyk
In all the reporting about pain research, opioids are always declared ineffective for long-term chronic pain relief.
The full truth is that there have been NO long term studies and there is NO evidence proving they are INeffective either, but that isn’t mentioned.
This situation allows doctors and researchers to state only one side of the full truth, that there is no evidence opioids are effective and still feel like they are telling the “truth”.
This half-truth has created a nightmare scenario for pain patients: Continue reading
This is an inclusive survey for all opioid users (legitimate or illegal), their family members, and physicians. It seems designed to capture a comprehensive snapshot of the situation.
We’re interested in hearing about how the opioid epidemic and the public health response to it are affecting patients and doctors, family members and addicts.
This survey will be used by the Bend Bulletin, a daily newspaper in Bend, Oregon, to gather information on how the opioid epidemic has impacted different types of people, and to track how efforts to address the crisis are impacting them.
A unique characteristic of the survey is that it does not assume you are either a patient of a person with addiction, but lets you state your relationship to these drugs: Continue reading