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In general, people that received opioids reported more pain relief and had less difficulty performing their daily activities in the short-term than those who received a placebo. However, there is little data about the benefits of opioids based on objective measures of physical functioning. We have no information from randomized controlled trials supporting the efficacy and safety of opioids used for more than four months. Furthermore, the current literature does not support that opioids are more effective than other groups of analgesics for LBP such as anti-inflammatories or antidepressants
Most of the trials followed the patients during three months and were supported by the pharmaceutical industry.
(note: short term studies - <1 day. intermediate-term - 6-12 weeks.)Short-term studies produced mixed results, with just over half indicating that opioids might be better than a placebo. While intermediate-term studies all indicated that opioids were better than placebo, most studies were small, most were short, and none used methods known to be unbiased. All these features are likely to make effects of opioids look better in clinical trials than they are in clinical practice. We cannot say whether opioids are better than placebo for neuropathic pain over the long term. Side effects such as constipation, nausea, dizziness, and drowsiness were common, but not life-threatening.
You must not be aware of the NEWEST mu super-agonistically-antagonist slow release fomulation, which is delivered by LASER. It is shown by a Medtronic-sponsored study to be 1% more effective than placebo (which involves slapping the patient in the face).So, we are slowly coming to the conclusion that just as many other specialties (with the exception of rheumatology for RA and psoriatic arthritis), we lack the tools as pain physicians to adequately treat most chronic pain. It will be interesting to observe the specialty evolve from this point onward....into acute pain? experimental medicine? supplements?
Cochrane did an analysis on 15 RCTs with opioids and found that in 13 out of 15 trials, the opioids did show clinical improvement.
The use of opioids for chronic pain currently is because we have few other viable long term options for the treatment of chronic pain. The risk/benefit ratio is higher with opioids than with other treatments but can be mitigated through control by the physician.
In some ways chronic pain treatment is like that of treating cancer with chemotherapy....there are cocktails that are more lethal than others but these risks are weighed by the physician and patient. The fact that without such cocktails, cancer patients will die and chronic pain patients may not die, is lost on chronic pain patients who live in excruciating life changing pain everyday. They want relief. The lethal cocktails provided as treatment for chronic pain were handed out injudiciously by doctors rather than weighing risks/benefits, and now law enforcement/tort attorneys/medical boards/and attorney generals are forcing doctors to prescribe less lethal cocktails to society. This is a just and warranted effort on their part, and is not simply cruelty to chronic pain patients. But pushed to the extreme, there will be more chronic pain patient deaths from suicide, much more rapid embracement of SSD by patients who have no alternative, and a whole society that may reel against the medical profession due to a perceived lack of compassion. Nurses have compassion and doctors don't will be the message, and patients will flock to NPs that will prescribe hydrocodone whereas their opioid-phobic physicians will not. Effectively, pain patients will become stratified into those that respond to injections, provided injections are still covered by insurance, and those that don't want injections who will see non-physicians. Until the NPs begin doing injections routinely. Certainly this is one possible outcome that will be embraced by those physicians that despise opioids however, are there enough patients that will subscribe to the needle only therapy to keep physicians employed especially given the increasing scrutiny of insurers over injections (that have their own risk/benefit ratios that appear to be increasing according to the feds)? Is there a possibility the pendulum will swing so far as to bring further scrutiny on the pain profession's other side- needles and investigational procedure cash practices?
Cochrane did an analysis on 15 RCTs with opioids and found that in 13 out of 15 trials, the opioids did show clinical improvement.
The use of opioids for chronic pain currently is because we have few other viable long term options for the treatment of chronic pain. The risk/benefit ratio is higher with opioids than with other treatments but can be mitigated through control by the physician.
In some ways chronic pain treatment is like that of treating cancer with chemotherapy....there are cocktails that are more lethal than others but these risks are weighed by the physician and patient. The fact that without such cocktails, cancer patients will die and chronic pain patients may not die, is lost on chronic pain patients who live in excruciating life changing pain everyday. They want relief. The lethal cocktails provided as treatment for chronic pain were handed out injudiciously by doctors rather than weighing risks/benefits, and now law enforcement/tort attorneys/medical boards/and attorney generals are forcing doctors to prescribe less lethal cocktails to society. This is a just and warranted effort on their part, and is not simply cruelty to chronic pain patients. But pushed to the extreme, there will be more chronic pain patient deaths from suicide, much more rapid embracement of SSD by patients who have no alternative, and a whole society that may reel against the medical profession due to a perceived lack of compassion. Nurses have compassion and doctors don't will be the message, and patients will flock to NPs that will prescribe hydrocodone whereas their opioid-phobic physicians will not. Effectively, pain patients will become stratified into those that respond to injections, provided injections are still covered by insurance, and those that don't want injections who will see non-physicians. Until the NPs begin doing injections routinely. Certainly this is one possible outcome that will be embraced by those physicians that despise opioids however, are there enough patients that will subscribe to the needle only therapy to keep physicians employed especially given the increasing scrutiny of insurers over injections (that have their own risk/benefit ratios that appear to be increasing according to the feds)? Is there a possibility the pendulum will swing so far as to bring further scrutiny on the pain profession's other side- needles and investigational procedure cash practices?
vs uniform condemnation of any opioid prescribing for more than 2 months will set the stage for the tort and prosecutorial law for many years.
I agree. "Think before you throw stones in your glass house."The trouble with the French Revolution is that those deciding whose necks were to meet the sharp blade of madame Guillotine later were viewed as conspirators and counter-revolutionaries by the standards of others, and they then became the victims of the blood lust.
Those that espouse some arbitrary practice of medicine based on their own experience rather than a thorough understanding of EBM and testify in court against others based on their arbitrary practice model as a standard of care may find their own standards to be far too liberal for others. This is especially true with opioids for chronic pain. Even treating one patient long term with opioids will be viewed by some as hypocrisy and substandard care by some. The blade is very sharp and can be used by governments, prosecutors in criminal proceedings, plaintiff's attorneys in secondary wrongful death suits, against any physicians prescribing opioids long or short term. The behavior of the medical community in adopting a measured but firm response to the opioid overprescribing in this country vs uniform condemnation of any opioid prescribing for more than 2 months will set the stage for the tort and prosecutorial law for many years.
Aquatic therapyThere are very few treatments in chronic pain that offer much more than modest relief long term...
agreed, but again, we are probably - and the typical pain patient - is remained fixated on "relief".There are very few treatments in chronic pain that offer much more than modest relief long term...
As is typical of most "chronic" conditions, ie, hypertension, diabetes, obesity, allergy, mental illness, auto-immune conditions, renal disease. That's why we are needed, for ongoing treatments, etc. (Obviously you know that, but sometimes it's worth stating the obvious, for the people that don't get it.)There are very few treatments in chronic pain that offer much more than modest relief long term...