Evaluation of US Food and Drug Administration-recommended abuse-potential questions in chronic pain patients without history of recreational opioid use: results and plan for research – free full-text /PMC6301309/ – Dec 2018
Existing patient-reported outcome (PRO) assessments that measure the human abuse potential for opioid analgesics have been tested exclusively in experienced recreational opioid users, as required by US Food and Drug Administration (FDA) guidance.
The goals of the current studies were to modify items from FDA-recommended abuse potential PRO assessments to specify the analgesic benefits versus the euphoric effects of opioids and to ascertain the clarity, understandability, appropriateness, and validity of the modified questions. Continue reading
Again I found a lot of useful information about this topic from the user “Seshet” in the long-running and up-to-the-minute “Opioid Information Thread” from the Inspire.com support forums. I’ve excerpted his summary of reviews of non-opioid therapies:
I’ve been collecting Cochrane reviews for years. They are very handy for understanding the general consensus about a particular treatment option for a specific condition.
But they are not necessarily current because Cochrane produces reviews of reviews and not cutting-edge original research. So it’s possible that there are new or experimental therapies that may be helpful for a particular disorder, and Cochrane simply won’t have anything about them. Continue reading
Depression treatment needs overhaul – by Tess Redgrave, University of Auckland
This is an interesting article that proposes 12 categories of depression, with different symptoms and requiring different treatment.
The way depression is diagnosed and treated needs a major overhaul, say authors of a new review article in the scientific journal Brain, Behavior, and Immunity.
This is because current treatment of depression is ineffective and lacks a plausible, coherent theoretical basis, they claim.
A new theory for depression and its treatment is proposed in the article “Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions,” Continue reading
C-reactive protein and cold-pressor tolerance in the general population: PAIN – July 2017
I’m reposting this study because it explains that hyperalgesia, which is blamed on opioids, arises from chronic inflammation and the numerous chemical changes this causes in the body over time.
Pain and inflammation are related:
systemic inflammation may lead to a variety of pain states, and, in turn, persistent pain causes an upward adjustment of proinflammatory mediators that sometimes elicit a prolonged low-grade immune response, leading to long-lasting, subclinical inflammation.
Classifying Chronic Pain Using the American Pain Society’s Taxonomy – Helen Fosam, PhD – November 07, 2016
a systematic review identified several psychosocial variables that contribute to the transition from acute to chronic pain.
These factors, considered to have a greater influence than biomedical and social variables, include
- previous traumatic experience in childhood,
- challenges and distress in daily life, [living with constant pain is in itself a distressing challenge – zyp]
- coping behavior, [I suspect they mean “avoiding pain”, in which they take a normal evolved behavior designed for survival and turn it into a cause of our own pain -zyp]
- anxiety, depression [almost all patients with pain that has lasted for years eventually fall into these states -zyp]
- work dissatisfaction.
Are Anticonvulsants Effective for Low Back Pain? – MPR – Diana Ernst, RPh – July 2018
Here’s another review showing that anticonvulsants (anti-epileptics like Lyrica and gabapentin) are not effective for pain, even though they are increasingly prescribed for it.
For no other purpose than to avoid using opioids, pain patients are being prescribed all kinds of drugs off-label because they may be effective for some kinds of pain is some people some of the time.
Pain management doctors are forced to practice medicine based on hope, not evidence, when the most effective drugs for this condition are prohibited due to their potential damage to patients who may potentially abuse them and potentially develop an addiction. Continue reading
Uncritical Publication of a Biased Study Leads to Misleading Media Reports | Pain Medicine | Oxford Academic – Lynn R Webster, MD – 20 November 2018
Dr. Webster points out how much harm is done when sloppy and biased research results are handed to reporters, often with a dramatic positive spin.
On March 6, 2018, (JAMA) published a manuscript titled “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial,” by Krebs et al. …results of the study led to headlines in major news outlets touting proof that opioids were not for chronic noncancer pain. [Ironically, “Krebs Study” Shows Opioids are Safe]
The article is in the top 5% of all research outputs measured by Altmetric: As of this writing, 313 news stories from 191 outlets, 2 278 tweeters, 45 Facebook pages, nine blogs, and seven Redditors have reported on the study. [See Popular Article on Opioids is Misleading] Continue reading
A tweet from one of our champions for pain patient access to opioids, Dr. Stefan Kertesz (@StefanKertesz) identifies major problems in a study supposedly showing that prescription deaths decreased in states where PDMP was instituted:
Survey says… Pain Intensity or Pain Frequency? — The PIRL – from The Pain and Quality of Life Integrational Research Lab – May 20, 2015
Here at the PIRL we subscribe to the ‘pain is what the patient says it is, and occurs when the patient says it does’ doctrine, regardless of what is happening in their other physiological systems (although we poke around in those as well).
…we’ve also been working on the “MSK [muscloskeletal system] Symptom Index” (MSI). The symptoms on the MSI have been informed directly by our patient informants. They identified several symptoms that were not captured on any symptom intensity scale we could find.
Instead of a single momentary measure of intensity, these folks have been working on better measurement of the unpleasantness/suffering caused by various types and expressions of pain. Continue reading
The MultiDimensional Symptom Index: A New Tool for Rapid Phenotyping of People in Pain – October 2, 2018 by Dave Walton
I found this article interesting because it tries to measure pain and recovery according to the patient’s perspective, not that of outside observers. This kind of pain scale takes into account the variety of intensity, frequency, and interference, which I find much more valid and complete than just a single number.
My favourite projects are those in which I and my collaborators have identified a gap in available tools and created something entirely new from the ground up.
One of our first was the Traumatic Injuries Distress Scale (TIDS). After 11 iterations that tool now appears to be functioning quite well for establishing prognosis after acute MSK [musculoskeletal] trauma. Continue reading