Tag Archives: opioids

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

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