Increasing placebo responses over time in U.S. clinical trials of neuropathic pain.

[101N]

Pain. 2015 Aug 22. [Epub ahead of print]
Increasing placebo responses over time in U.S. clinical trials of neuropathic pain.
Tuttle AH1, Tohyama S, Ramsay T, Kimmelman J, Schweinhardt P, Bennett GJ, Mogil JS.
Author information

Abstract
Recent failures of clinical trials of novel analgesics designed to treat neuropathic pain have led to much speculation about the underlying reasons. One oft-discussed possibility is that the placebo response in these trials has increased in recent years, leading to lower separation between the drug and placebo arms. Whether this has indeed occurred has not yet been adequately addressed. Here, we extracted data from published randomized controlled trials (RCTs) of drugs for the treatment of chronic neuropathic pain over the years 1990-2013. We find that placebo responses have increased considerably over this period, but drug responses have remained stable, leading to diminished treatment advantage. This trend has been driven by studies conducted in the U.S.A. Consideration of participant and study characteristics revealed that in the U.S.A. but not elsewhere, RCTs have increased in study size and length. These changes are associated with larger placebo response. Analysis of individual RCT time courses showed different kinetics for the treatment versus placebo responses, with the former evolving more quickly than the latter and plateauing, such that maximum treatment advantage was achieved within 4 weeks.

Hmm... I wonder if there is any connection to this:


BTW: David Hart is a rock star

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Members don't see this ad.

 

[drusso]

Hmm... I wonder if there is any connection to this:

Or, this: Talk about "Detrimental Reliance."

http://www.bostonherald.com/news_op...0/doctors_pioneer_pot_as_an_opioid_substitute

I'm not buying the hype that pot is "safer."

 

[101N]

There is no question that THC use is safer than opioid use, or alcohol use, or tobacco use. However, there is no data to suggest that patients - given the either or choice - would
select THC preferentially over opioids. Or that THC use results in a reduction in opioid use. Alcohol consumption has gone up on WA and CO since legalization.

 

[bedrock]

I don't have the reference on me, but I recall someone posting here a few months ago, a study that demonstrates decreased opioid use and notably fewer deaths from overdose, in patients who were also smoking weed.

It makes sense, unfortunately it won't change my clinical prescribing habits until MJ is legal on federal level so my DEA isn't threatened if I prescribe opioids to someone also taking MJ.

 

[lobelsteve]

There is no question that THC use is safer than opioid use, or alcohol use, or tobacco use. However, there is no data to suggest that patients - given the either or choice - would
select THC preferentially over opioids. Or that THC use results in a reduction in opioid use. Alcohol consumption has gone up on WA and CO since legalization.

But the data for efficacy is horrible....without benefit, why take risk?

 

[drusso]

There is no question that THC use is safer than opioid use, or alcohol use, or tobacco use.

Wow, I am not so certain. Does anyone have published data on REMS or SBIRT process for retail versus medical cannabis in the medical setting?

 

[101N]

I guess it's a matter of priorities. With 17K deaths a year due to opioids or opioid/benzo combo's it seems
smart to focus there. While pot is addictive for adolescents and trouble for some adults, it's not on the
magnitude of alcohol, tobacco, or opioids. And, we don't prescribe it.

https://public.health.oregon.gov/Di...ata/Documents/oregon-drug-overdose-report.pdf

 

[drusso]

And, we don't prescribe it.

Well, Doctors are standing by...

http://portlandalternativeclinic.com/

 

[Ducttape]

the MJ advocates are clearly using a ruse.

arguing that MJ is safer than alcohol should in no way justify legitemizing MJ. the risks of each one should generally be considered separately (the exception being when there is high likelihood that they will be combined)

i dont buy in "well, let them use MJ instead of EtOH because MJ is safer". especially when there is a high risk that both intoxicants will be used concurrently.

 

[lobelsteve]

the MJ advocates are clearly using a ruse.

arguing that MJ is safer than alcohol should in no way justify legitemizing MJ. the risks of each one should generally be considered separately (the exception being when there is high likelihood that they will be combined)

i dont buy in "well, let them use MJ instead of EtOH because MJ is safer". especially when there is a high risk that both intoxicants will be used concurrently.

22 cal is safer than 45 cal. Good argument. I really do not want either of them IM or intraperitoneal.