Tag Archives: research

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.  

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Brain abnormalities are Consequence Not Cause of pain

Brain Gray Matter Decrease in Chronic Pain Is the Consequence and Not the Cause of Pain | Journal of Neuroscience Nov 2009

If you can reverse brain “damage” by effectively treating the patient’s chronic pain, it seems pretty clear that the chronic pain was the cause.

This means we don’t have to accept the idea that abnormalities in our brains are what’s causing our pain (which some have hinted at).

Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were reported in patients suffering from chronic pain.

Although some authors discussed these findings as damage or loss of brain gray matter, one of the key questions is whether these structural alterations in the cerebral pain-transmitting network precede or succeed the chronicity of pain.   Continue reading

Complex Chronic Pain Disorders

Complex Chronic Pain Disorders By Don L. Goldenberg, MD – Feb 2019

The pathophysiology of and approaches to 3 commonly seen pain conditions: CRPS, EDS, and SFN.

  • Complex regional pain syndrome (CRPS),
  • Ehlers-Danlos syndrome (EDS), and
  • small fiber neuropathy (SFN)

are three important and complex chronic pain disorders.   Continue reading

The Problem with Surrogate Endpoints

The Problem with Surrogate Endpoints – Alex Gertner – Twitter stream from @setmoreoff – Feb 2019

Mr. Gertner shows why you cannot measure drug use by counting various “surrogate outcomes” like those listed below and expect to get a realistic number.  Measurements can be dramatically skewed and lead to wildly inaccurate results when invalid surrogate endpoints are chosen.

1/ If you’d like to research the effect of a policy or program on drug use rates then you need to measure drug use.

  • ED overdose visits,
  • drug related arrests, and
  • overdose deaths

are not good measures of drug use rates. Thoughts from >10 years working in drug policy & research   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

18-yr Trends in Noncancer Pain in the United States

Eighteen-Year Trends in the Prevalence of, and Health Care Use for, Noncancer Pain in the United States: Data from the Medical Expenditure Panel Survey – Jan 2019

We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management.

This study compared data from 1997/1998 to data from 2013/2014. The numbers are given in percentages, which can be misleading if population growth isn’t taken into account. 

Also, by 2013/2014, fewer doctors were willing to prescribe opioids for chronic pain and the ones that still did, only prescribed minimal doses. At some point, a pain patient realizes they will no longer get pain relief from the medical system and gives up, goes home, and stays in bed.  Continue reading

Assumptions: Often Wrong, Never in Doubt

Often Wrong, Never in Doubt – Six Ways Assumptions Mislead Us – By Chuck Dinerstein — December 19, 2018

Facts are far harder to obtain than assumptions; they may require long periods of observations or expensive, sensitive measurement devices.

Assumptions can be made more easily, in the comfort of the office, frequently papering over or shaping missing data.

One of the unintended results of this approach is that given a limited set of facts, the strength of our conclusions is based upon our certainty in the strength of our assumptions.

Assumptions are just not as sexy as conclusions and are frequently overlooked in our haste to know or do – it is a variation of often wrong, never in doubt.   Continue reading

Research Reporting Bias in Clinical Trials

As our healthcare system shifts to corporate ownership, the drive to generate profits is destroying healthcare (and all other social services).

When decisions are made on a financial basis instead of patient welfare, inappropriate standardization is applied where human variety is critically important: the fluctuating biochemistry of our individual bodies and how they react to interventions.

Here are 3 PubMed studies showing how research is corrupted by financial motives:

Frequency and reasons for outcome reporting bias in clinical trials: interviews with trialists – free full-text /PMC3016816/ – Jan 2011   Continue reading

Dead Salmon Shows Brain Waves in fMRI Scanner

Scanning Dead Salmon in fMRI Machine Highlights Risk of Red Herrings – Wired.com – by Lexis Madrigal – Sep 2009

Here’s a humorous, but also dead serious (pardon the pun), study pointing out the HUGE problems with fMRI brain scans that supposedly tell us something about what we’re thinking or feeling.

Neuroscientist Craig Bennett purchased a whole Atlantic salmon, took it to a lab at Dartmouth, and put it into an fMRI machine used to study the brain. The beautiful fish was to be the lab’s test object as they worked out some new methods.

So, as the fish sat in the scanner, they showed it “a series of photographs depicting human individuals in social situations.” To maintain the rigor of the protocol (and perhaps because it was hilarious), the salmon, just like a human test subject, “was asked to determine what emotion the individual in the photo must have been experiencing.”   Continue reading

The Trouble with Meta-Analyses

The trouble with Meta-Analyses – Thoughts About How They Should Contribute to Medical Science and Practice – by Milton Packer – Nov 2017

Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute?

Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial.

This commentary explains why this cannot possibly be true.   Continue reading