I had no idea. I guess I need to study more of the pharmacy side of this evil disease than the symptoms. I will talk to my PCP. I am tired of living my life in a recliner or bed. It takes me 4 or 5 hours to get over taking a shower. :) You have been so much help! Thank you so much!
I have to agree Nykki. I am unable to NSAID's of any kind due to GI troubles. I have run the gamete of medications that are supposed to be helpful for Fibro, but nothing has worked or interfered with my psych meds so much it was not safe for me to use the drug.
I do not take the Hydrocodone lightly, I cry every time I have to take it because I am so afraid of becoming addicted or being called a drug addict. Now with all the changes in the laws and class of hydro it will make very difficult to get. I got my first triplicate prescription sheet today, I took it to my pharmacy to fill and was told they won't have the medication for 2-3 months because they haven't fixed their systems to be able to fill it. So, due to the drug agreement with the doctors office I have to get permission from my doctor to fill at a different pharmacy, if I can find one that will be able to fill it.
It is coming up on a very busy season for me with the holidays, travel and other things. I am so afraid of be stuck somewhere in a huge flare and in so much pain with no ability to help it. I mean the world has become a 24/7 demanding place and if you can't keep up you are shunned. So just resting and lowering stress or adding many appointments with several different therapists is not easy. It makes one just as unemployable as not treating them.
I do understand that some people abuse them and rebound pain, etc. But for some people there is very little option and it is used wisely.
Thanks for the info dancermom,
I know many people here rely on opioids for pain control, and please don’t think I’m having a go at those who have no option but to take them, but it has been a concern to me that a lot of docs have (in my own experience) gone to prescribe opioids before trying other pain control options. I can only speak of my own experience in healthcare and of my own conditions, but I have noted that often the less experienced doctors are often the ones to jump to use the “big guns” in the pain management arsenal whereas the consultants will be more conservative in their use of opioids, steroids etc and appear to consider their choice of pain management more carefully.
I have searched the web on this but would appreciate any other input. Is tramadol considered an opiod when these subjects are discussed? It is not considered a narcotic but is listed as an opiod.
I know that my life (social and activity levels) would come to a crashing halt if I did not have this along with my gabapentin. I think all of them need to re-evaluate the risks compared to the life we can lead with the use of them. I am going to look into the hands on experience Franklin actually has with patients. If he is busy with research and being a professor his whole outlook is hogwash.
It’s actually a synthetic opioid, and the term “narcotic” is usually a legal one describing either all illegal drugs or only opiates. However, narcotic and opiate are often used interchangeably. There. I made it more confusing!
Okay, this is what I found
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Opioid Risks Outweigh Benefits for Many Common Non-Cancer Pain Indications
- September 30, 2014
- 0 Comments
By Will Boggs MD
NEW YORK - The risks associated with opioid use for chronic noncancer pain outweigh the benefits for many of the most common indications, according to a new position paper from the American Academy of Neurology.
"The most important point of the article is that for the more routine pain conditions, those with mostly mild to moderate pain, such as low back pain (and other musculoskeletal conditions), headaches, and fibromyalgia, the risk benefit equation does not favor routine use of opioids, and they generally should not be used," Dr. Gary M. Franklin from the University of Washington in Seattle, the sole author of the position paper, told Reuters Health by email.
Writing September 30th online in Neurology, Dr. Franklin reviewed the key causes of the epidemic in deaths from prescribed opioids, the evidence for their safety and effectiveness for chronic pain, federal and state policy responses, and recommendations for neurologists to increase the use of best practices most likely to improve the effective and safe use of opioids while reducing the likelihood of severe adverse and overdose events.
Although evidence supports the effectiveness of acute opioid use for various kinds of noncancer pain, there is no substantial evidence for maintenance of pain relief over longer periods of time or for improved physical function, he maintains.
In recent years, deaths from prescription opioids have exceeded deaths from firearms and motor vehicle accidents in persons aged 35 to 54 years, and now unintentional poisoning deaths account for 20% of years of potential life lost before age 65.
As a result, several states have begun to recommend or require prescribing providers to seek consultation for patients who exceed a certain dose of opioid without substantial improvement of pain and function.
Accordingly, the American Academy of Neurology recommends several best practices to support the safe and effective use of opioids for chronic noncancer pain, including these "most crucial" best practices:
- Track pain and function at every visit - Document the daily morphine equivalent dose (MED) from all sources of opioids at every visit - Use the state Prescription Drug Monitoring Program (PDMP) to monitor all sources of controlled substances - Screen for prior or current substance abuse/misuse and for depression, anxiety, and posttraumatic stress disorder before initiating chronic therapy - Use random urine drug screening prior to initiating therapy and periodically during therapy - Use a patient treatment agreement - Avoid escalating doses above 80-120 mg/d MED.
"Recognize that any patient on opioids for over 90 days is likely physically dependent, and may have difficulty discontinuing opioids," Dr. Franklin added in his email. "Use of opioids in injured workers for routine musculoskeletal conditions is likely contributing to the initiation and perpetuation of disability."
"The most important thing now is to increase use of non-opioid modalities to effectively treat acute/subacute pain and to prevent the transition to chronic pain; these would include graded exercise, cognitive behavioral techniques such as activity coaching, and addressing psychosocial barriers to recovery, especially fear avoidance and catastrophizing," Dr. Franklin concluded. "Then, effective services that address chronic pain should be (incentivized), such as multidisciplinary rehab."
Dr. Charles E. Argoff from Albany Medical College in Albany, New York has written extensively on pain management and recently published a report on the safe use of opioids for chronic pain. He has several concerns about the new position paper. In particular, he told Reuters Health by email, with just one author the statement appears to represent the views of a single person.
"How can the position statement of a large professional organization be written by one person?" Dr. Argoff asked.
He added, "The reader should recognize that prescribing chronic opioid therapy for chronic pain (cancer related or non-cancer related) requires not only a certain skill-set, but also the willingness to monitor the patients for whom this is prescribed appropriately. I believe that of all the practices listed, the concept that dose does matter is among the most important, but recognizing this alone is not enough to optimize treatment outcomes with this therapeutic approach to chronic pain."
Dr. Argoff disputes the claim in the position statement that there is a dearth of evidence supporting chronic pain relief with opioids. "No extended-release/long-acting (ER/LA) opioid that has been recently FDA approved has received such (approval) without a minimum of 52 weeks of study - yes, 52 weeks! - not the 12 weeks that is so commonly incorrectly stated," he said in his email. "The fact that Dr. Franklin omits this fact in this position statement highlights his personal bias against the use of chronic opioid therapy."
SOURCE: http://bit.ly/1CDWnSJ
Neurology 2014;83:1277-1284.
(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp
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"Opiod Risks Outweigh benefits of many common non-cancer pain indications" by William Boss
"Dr.Charles E.Argoff from Albany Medical college in Albany has written extensively on pain management and recently published a report on the safe use of opiods for chronic pain. He has several concerns about the new position paper.In particular, he told Reuters Health by email, with just one author the statement appears to represent the views of a single person. "How can the position statement of a large professional organization be written by one person?" Although evidence supports the effectiveness of acute opiod use for various kinds of nancancer pain, there is no substantial evidence for maintenance of pain relief over longer periods of time or improved physical function he maintains"
." "
Thank you Grumpycat.that's funny
I’m glad you got my joke!
Thanks of all of that. It’s really a great article. I may reference it later, if you don’t mind.
Dr.Charles Argoff is a researcher and a clinician (treats people).
"Neurologist and pain management experts who reviewed the position paper but were not involved with it offered a mixed review. Most agreed that the need for judicious prescribing was warranted but some felt that the paper had mischaracterized available research"
Dr.Katz-"There's actually a lot of evidence for the longterm efficacy of opiods The evidence is similar in quality and quanity as for any other longterm analgesic....."He agreed that longterm randomized controlled trials would offer stronger evidence but to say there is no longterm evidence is a mischarcterization." Neurology Today October 2014
I am sorry for this long script. I thought I had deleted it. I new at cut and paste and this attempt was a complete faillure.
dozer, I like your thinking. It is good to check out the author's credentials and potential biases, especially on a topic as politicized as opioid use. If you find other publications by Franklin's critics, feel free to post them. One of the terrific things about a group like this is that many perspectives and viewpoints can be applied to an issue, and looking at the aggregate opinions can be very educational.
Thank you dancermom, it is nice to know people do appreciate a variety of opinions