Tag Archives: opioids

Patient Perspectives on Opioids

Patient Perspectives on Opioids: Views of Inpatient Veterans with Chronic Pain | Pain Medicine | Oxford Academic – July 2018

Objective: To elucidate perspectives on opioids and opioid use from hospitalized veterans with comorbid chronic pain using qualitative methods.

Design:

This was an analysis of individual qualitative interviews.

The semistructured interview guide was developed by a hospitalist with clinical expertise in pain treatment with guidance from a medical anthropologist.   

I’m surprised and baffled to see that a “medical anthropologist” was involved. With just this abstract available, I have no idea why or what for.  Continue reading

Opioid Tapering: Less, Same, or Worse Pain?

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 – PubMed – NCBI – Pain Med. 2018 Dec

This study’s bizarre findings can be explained by the same flaws I pointed out in a previous post of another study on tapering: Opioid cessation and chronic pain

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.

Methods:

Of 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain levels.

Here’s the first problem I see: the inclusion of only 5% of the references. This would allow for considerable bias, especially since the quality of the chosen studies was so low.  Continue reading

Are WHO Pain Tx Guidelines just Purdue Marketing?

Lawmakers contend WHO pain treatment guidelines are really Purdue ‘marketing materials – By ED SILVERMAN @Pharmalot MAY 22, 2019 – (article athttps://www.statnews.com/pharmalot/2019/05/22/purdue-opioids-world-health-guidelines/” accessible only through subscription to StatPlus)

Just the two first paragraphs of visible preview are astonishing and so infuriating that I’ll just leave you with these two:

Two  lawmakers are urging the World Health Organization to rescind guidelines issued nearly a decade ago for treating pain because they contain “dangerously misleading” and sometimes “outright false claims” about the safety and effectiveness that were orchestrated by Purdue Pharma.

In a new report, the lawmakers contend that the WHO guidelines, which were released in 2011 and 2012, are “serving as marketing materials for Purdue.” And they pointed to efforts by the company to create and fund front groups that participated in research that shaped WHO decision making – and dovetailed with corporate goals to boost use of opioids, such as its own OxyContin pill.

FDA warns against sudden discontinuation of opioids

FDA identifies sudden discontinuation of opioid pain medicinesfda.gov – Apr 2019

I don’t know how I missed this until now. If your doctor is trying to force you into a taper, you can let them know that the FDA warns against taking opioids away from pain patients without a medical reason and then only in a carefully planned extremely gradual taper.

The U.S. Food and Drug Administration (FDA) has received reports of  serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased.

These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.    Continue reading

Opiods as Antidepressants

Opiates as antidepressants. – PubMed – NCBI – Curr Pharm Des. 2009

Antidepressants are frequently touted as useful for chronic pain and it’s not clear if that is because they relieve pain-induced depression and thus make the pain less bothersome or if they specifically relieve the pain.

Here are two research studies showing that opioids may directly relieve depression, not just pain, further complicating the two-way relationships between pain and depression and also between pain-relievers and “depression-relievers”.

The pathophysiology of mood disorders involves several genetic and social predisposing factors, as well as a dysregulated response to a chronic stressor, i.e. chronic pain. Continue reading

Opioids enhance some antidepressants

Cooperative opioid and serotonergic mechanisms generate superior antidepressant-like effects in a mice model of depression | International Journal of Neuropsychopharmacology | Oxford Academic – free full text – September 2009

Perhaps this is another way that opioids help us deal with chronic pain. I know I’m more depressed when I’m having serious pain because it reminds me of all I’ve had to give up because of it. My future looks pretty grim when viewed through a thick haze of pain.

On days my pain isn’t so bad or I’ve managed to get it under control with opioid medication, I feel more hopeful about the future as I busy myself with all kinds of little tasks I cannot do when my pain is bad.

The opioid system has been implicated in the aetiology of depression, and some preclinical and clinical data suggest that opioids possess a genuine antidepressant-like effect.

Continue reading

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