Further News on Opioids from the National Pain Foundation

General
1

http://americannewsreport.com/nationalpainreport/neurologists-opioid-risks-outweigh-benefits-8824947.html

Neurologists: Opioid Risks Outweigh Benefits

September 29th, 2014 by Pat Anson, Editor

A leading U.S. medical organization is urging its members not prescribe opioid painkillers to patients suffering from fibromyalgia, low back pain or headaches, because the risk of serious side effects outweighs the benefits of pain relief.

“Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction,” wrote Gary M. Franklin, MD, in a position paper published in Neurology, the official medical journal of the American Academy of Neurology (AAN).

The Academy represents 28,000 neurologists and other healthcare providers who treat a wide variety of neurological disorders, including neuropathy, migraine, multiple sclerosis, epilepsy, and Alzheimer’s disease.

“It seems likely that, in the long run, the use of opioids chronically for most routine conditions, such as chronic low back pain, chronic headaches, or fibromyalgia, will not prove to be worth the risk,” said Franklin, a research professor in the Department of Environmental & Occupational Health Sciences at the University of Washington’s School of Public Health.

“Even for more severe conditions, such as destructive rheumatoid arthritis, sickle-cell disease, severe collagen disease, or severe neuropathic pain, prescribers need specific guidance on dosing, publicly available brief tools to effectively screen patients for risk, and guidance on how to monitor patients for early signs of severe adverse events, misuse, or opioid use disorder.”

Over 100,000 people have died from prescription opioid use since the late 1990s, according to Franklin, when policies were liberalized to promote the use of opioids for non-cancer pain. Studies have shown that about half of patients taking opioids for at least three months are still on opioids five years later.

“For some time the opioid data have failed to show significant benefit for headache, migraine, low back pain, irritable bowel disorder, and fibromyalgia; the AAN position paper is underscoring that opioids should be avoided in these conditions,” said Beth Darnall, PhD, a pain psychologist and author of Less Pain, Fewer Pills.

“We should be steering patients in the direction of non-pharmacologic treatments: pain psychology (where they may learn information, skills, and techniques to dampen pain processing), physical therapy, and acupuncture. These are just a few options. We know that chronic pain is best treated using a multidisciplinary approach.”

While opioid pain medications are generally not prescribed for fibromyalgia, nearly 60% of women with the disorder are currently taking opioids, according to a recent survey of over 2,400 women by National Pain Report.

“If chronic pain interferes with a person’s ability to function and participate in other treatment modalities, they should be treated with medication and other integrative therapies,” said Celeste Cooper, RN, a patient advocate and fibromyalgia sufferer who argues against a “one size fits all” approach to pain management.

“Some patients respond differently to certain medications, even within the same diagnosis population. In order words, we need a consistent plan for assessment, but individualized care plans. Success should not only be measured by a reduction of pain on the one to ten scale, it should also be measured by function. How is the patient able to socialize, maintain relationships, and contribute?”

The AAN is recommending that doctors consult with a pain management specialist if their patient’s dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day. The Academy also recommends that its members take further steps to ensure that opioids are prescribed safely:

  • Have an opioid treatment agreement with patients
  • Screen patients for drug abuse and depression
  • Give patients random urine drug screens
  • Do not prescribe drugs such as sedative-hypnotics or benzodiazepines with opioids
  • Utilize prescription drug monitoring programs (PDMPs) to see what medications patients are taking

“More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs,” said Franklin.

2

I see a doctor in a clinic with several other doctors. They have hired a pain specialist doctor and have a physical therapy department that will be working with them to find ways to control pain and have a better quality of life for their patients.

3

That sounds like a good, cooperative approach, pb. It takes a multidisciplinary team.

4

i was on opiods for at least 20 years. I was taking them at least 4 x a day and for many years did get some relief and /or the edge was lifted. after some years i began noticing that i was still in a great deal of pain and could hardly move even while using opiods and i thought this was not making much sense. My primary doc began reading alot about opiods and about people actually dying in their sleep for one thing. Opiods repress the respirator system and people are often using other drugs along with these that also repress the respiratory system. I was also using benzodiazepines and benydryl to help me sleep. I began to research all of this info and i did get scared. And as i said i was getting no pain relief. I read about 'rebound'pain. When the drug wears off there is acually a feeling of the pain being 10 x worse than it originally was therefore becoming a vicious cylce where one is no longer getting any relief and feeling worse. That being said and what my medical doc told me i began to seek out a neurologist. ( i suffer with gran mal siezures ) and finally found one that i liked after 20 years. lol.. anyway.. He also talked to me about all of these things and told me that i was in fact over medicated and about the rebound pain and about the fear about suppressing the respiratory system often when people are sleeping. I then began to slowly wean myself of all the narcotics except for ativan which i take for anxiety and/ or panick attacks. I am doing other things to manage the pain .. I am not saying i am pain free but i no longer feel the need to take narcotics. I do have a small supply for EXTREME emergencies. I have degenerative disease of the entire spine and that includes the neck. I had a bad attack a few weeks ago and i could not move even my fingers at all for two days . I could barely breath without screaming from this pain. I took one perc. I have used total of 3 percs in over 1.5 years now. I recline often during the day and rest in between activities. I do not go to work so i am able to pace myself however needed. I will go to pt and get massage therapy and tens unit. i used to be able to get to a swimming pool and jacuzzi. i keep comfortable on couch and bed with various pillows ( neck also) I meditate and have such music when i go to sleep. As i said i am not pain free but not to the point where i was when i suffered with rebound pain from the narcs. for me taking them daily is too risky. narcs were never meant for long term use. I do take meds for the siezures whicvh may be helping some with pain and i take celebrex when needed. Thats my story about narcs. thanks dancermom for sharing this info..

5

Suzie, that is a really important story, and I am sure it will help someone, maybe several someones. Thank you for sharing it.

6

i hope so. most people with chronic pain have only shared the reasons and need for the narcs. i was in those convo's as well when i took them . I claimed i could not get out of bed without them nor walk , clean the house etc. So i never broached this subject because no one really wanted to hear it. All they know was that i stopped taking them and now i am off them for about 1.5 years. I am glad you put this info up which made me feel free to open up about my experience. thank you

HUGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGS

suzie

7

That is a very odd choice of words. Perhaps routine for those reading statistics, but anything but routine for those experiencing it. There is always that gap between patient experience and "the experts." The very best doctors are the ones who try to bridge that gap and see things from the patients' perspective.

8

of course that was certainly a wrong choice of words. People have often misunderstood me having a severe case of chronic fatigue immune dysfunction syndrome thinking i just need a good night sleep and some tylenol and not realizing when i say that i was totally bedridden (with a multitude of symptoms) for at least ten years that i meant it litterally. About this article though i was only speaking on the risks about long term use of narcotics and people such as myself with illnesses involving chronic pain go through

HUGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGS

suzie

9

Yes, the safety concerns are the important part of the message, to be sure.

10

I was on Ultram for 19 years and it worked but destroyed my liver. For a little over 3 months now I have been on Buprenorphine. I have FMS/CFIDS for over 20 years now and the only thing that helped for 19 years was Ultram. But like I said I am sure that is what caused a lot of my liver damage. I am not a drinker, never have been. The one thing I miss with the Ultram is it's effect to work as a SSRI and seemed to give me an energy boost, that is why I could never take it past 1-2PM or I would have sleep problems. Plus I could never take it if I woke up in the middle of the night in severe pain or I would be up for the remainder of the evening. I also have 2 herniated cervical disks, severe osteo arthritis, 2 bad discs in my lower back.

I took me many years to switch over to something as strong as Buprenorphine. It was nothing I did on a whim. But it allows me to work and continue to support myself. Also, my liver enzymes are pretty much back to normal, the Bup is taken sublingual so it bypasses first metabolisim, which is suppose to be easier Yon your liver. Yes it is much more addictive and a pain to re-fill etc. But it has allowed me to be more active, so I have been able to exercise a lot more, mostly walking but it has helped, I have lost 14 lbs in 3 months since I started it and I am sure it is e ot the fact that it allows me to be more active. I have known my Dr. for 20+ years and he is to me more of a concierge Dr. and we do have an agreement. I count my pills every day to make sure I don't miss a dose or by accident take too much. The first month on it I was much more tired, but that has worn off. But they way I take it, 1 8mg am, then 1 4mg 3x. So I was able to quit taking valium for sleep or remeron or a prescription sleeping pill.

The only thing I am worried about is I travel a lot. I have been asked to do some consulting work in Dubai, and I know they do not tolerate any drugs that strong in any country in the UAE. But I will just have to say no if my employer insists. I don't know if I could handle the long flight there anyways without going business or first. I am flying to Denver for work this Sunday and paid for an upgrade myself to First Class because it's over a 3 hour flight from Detroit and don't want to hurt after flying that long.

Back to the drug I think the benefits for me outweigh the negatives. I still have to use a cane every now and then, especially if I go and do some "picking" I own an antique shop also. The cane just helps me to keep my balance so I don't fall again, which would only make everything worse. I am putting off my neck surgery that they want to do and will do it as long as the Buprenorphine still works for me. After the first month I was at my maintenance does and have not had a need to increase.

So far it works for me. Oh, plus I have tried every natural pain killer, krill oil etc. nothing helps. I think at times I am a little more emotional on it, which could be the drug or not being on Ultram, hard to say. Not depression just a bit more emotional.

Fibro Hugs,

Bobby

11

why thank you mam!!!!!!!!!

HUGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGS

suzie

12

Bobby, I really appreciate you sharing your experience. Having coexisting conditions definitely makes pain management more complicated. I am glad you were able to find medications that help you stay active. All the best to you.

13

Bobby,

About your flying, I use a cane when I travel (it helps with long treks) and get a priority boarding pass for disability in order to get a bulkhead seat. It doesn’t cost any more to do that, but some don’t like to do that because it feels like taking advantage or makes them feel more disabled or like they’ve given up. I started out that way, but I don’t feel that way about my choice anymore. It helps me remain more able to live my life as I would like to and with less pain, and that’s what the ADA is all about. Anyway, I’ve been doing things this way for about two years now and it’s really helped, but never cost a dime.

14

I use a can when I know I will be walking around for a few hours. But to tell the truth I am afraid to have anyone that I work with see me using a cane. I was hassled at work when I had to take time off for a heart attack a year ago last February. I used to take my handicap card when I travel so when I am at a client I can park close to the door. I did that at a client in Florida about 2 years ago and my boss was working at the same client and asked me not to park there even though I have a handicap card, she said it does not look good that the client is paying big dollars for my work and I have health issues. As you can imagine you can probably gather from this that I am looking for another job.

Anyways, back to the cane. Recently I have been able to work from home for the past few weeks which in a way has helped a lot. But when I did Minnneapolis this past year for 7 months that was horrible. I normally have Platinum status on delta because I fly so much I get upgraded to first class 75% of the time. This Sunday when I leave for Denver I did not qualify , but for an extra 200 bucks I got first class, out of my own pocket of course, but it's worth it. It's a little over than 3 hours from Detroit to Denver. Plus I think I may call a car service to take me to the airport so I don't have to drive. I live about an hour from the airport. Again that too will have to come out of my own pocket but makes it so much nicer to travel. I may take my cane with me Sunday. Even though the airport has the tram and moving sidewalks it's still a lot of walking.

But as I said I sure like my cane when I go to outside functions that require a lot of walk and standing. Standing in one place hurts more than walkingI sometimes. Just to have the extra balance of the cane makes it easier so I can enjoy more things versus avoiding them.

Fibro Hugs,

Bobby

15

Boy do we ever suffer because a few people out there ruin it and make it bad for the people like us who really need opoids. I have never felt "high" from taking my pills. I think if you have real condition like ours you won't feel high. I guess that's why I don't understand people taking them to get a high because I have never felt that from any of my prescription opioids.

I think the thing we have to watch about opioids for our pain is what they mix them with. Acetometaphine is so deadly along, I don't know why they put it in Vics or many other pills. That will damage your liver more than another other prescription drug out there.

16

Same here, I used to have Vicodin for my back pain and it would make me nauseous and even vomit a few times, so I really had to be in bad pain to even consider taking 1 pill.

Now I have 5-325 Oxy/APAP, I take half and if the pain is not managed within an hour I take the other half. It takes me about 3 months to go through 30 pills. Never felt high at all, on either meds.

Opioids do NOT touch my Fibro pain at all, when I have both back and Fibro pain, the back pain is gone but the Fibro is still there.

It's easy for people to say do not take them or docs who do not want to prescribe them, I wish they could feel the pain people have and maybe it would change their minds. I my mind there is a difference between addiction and dependence. You can depend on a medication to make your pain go away, though the med can make you addicted to it. If you are addicted because you had a painful injury but you couldn't stop taking the meds, it's not the same thing.

Just compare it to alcohol, not everybody drinking it is an alcoholic. Should they make alcohol illegal because of the possibility of becoming an alcoholic? Oh, wait they tried that, it was called "Prohibition", which was a GIANT failure and people ended up drinking more than they did before. That makes you really think.

Just my opinion.

Hugs, Farida

17

Well said!



For the last 9-10 years, it’s been taught to medical professionals that “pain is the 6th vital sign” and treating pain has been a top priority. That’s a great concept, but it fell short in practice. A lot of docs prescribed opiates for every ache and pain, instead of reserving it for severe pain or trying drugs with less risk of abuse first. Many of the people who ended up abusing prescription opiates got their first prescription for a legitimate medical reason, from a legitimate doctor. Now we have a mess, and the end result to all of the governments attempts to eliminate Rx drug abuse has made the drugs harder to get for patients who need them, which makes no sense. Depending on the state, regulations have changed who can prescribe, how much of each drug a pharmacy can get, and introduced stringent prescribing guidelines, and more. It’s a mess. Some of the change has been good, but some of it has been silly. It seems that along with making addicts struggle to get their drugs, it’s made patients with legitimate needs struggle too. It seems that the baby has been thrown out with the bath water.

18

thanks Lovett and dancermom.. it was indeed a good catalyst for me to share my story, one that i dont seem to get to be able to or have the opportunity to.. HUGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGS

Suzie

19

Nykki,

My night meds are Flexaril, Norco, Gabapentin, 100 mg of Amytryptiline to make me sleepy. I have been on this amount for less than a month and I am already not sleeping well due to the pain. My doctor has offered me opiods but I refuse because my sister, who also has Fibro and CFS, is a Oxy junkie. I have never had an addictive personality, well except for chocolate and Dr. Pepper, but I am scared of it. I am just tired of hurting. My high tolerance for pain is gone! :)

20

Thank you, Bobby for sharing your story. I am so thankful I came across this group.

I have a cane, a walker, AND an electric wheelchair. My back was so messed up in the wreck and no injection the pain doctor gave me worked. I use a walker to get in to Walmart. It allows me a place to sit down and stretch my spine out ever 5 mins. If I want to go to the park with my grandboys, it is the wheelchair for Drandma :/