Kolodny: Just take APAP and NSAIDS.

[lobelsteve]

Kolodny: NSAIDs ‘Just as Effective As Opioids’ — Pain News Network

By Pat Anson, PNN Editor It’s fair to say that Dr. Andrew Kolodny is recognized as an expert in substance abuse. Koldony is board-certified in Psychiatry and Addiction Medicine , and for a few years was the Chief Medical Officer of Phoenix House, which operates a chain of addiction treatment cente

www.painnewsnetwork.org

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[Orin]

Opioid vs Nonopioid Medications on Pain-Related Function

This randomized clinical trial compares the effects of opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects among Veterans Affairs patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain.

jamanetwork.com

"""
Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5])."""

He's totally wrong. APAP and NSAIDs are better than opioids.

 

[lobelsteve]

Opioid vs Nonopioid Medications on Pain-Related Function

This randomized clinical trial compares the effects of opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects among Veterans Affairs patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain.

jamanetwork.com

"""
Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5])."""

He's totally wrong. APAP and NSAIDs are better than opioids.

"Patients on long-term opioid therapy were excluded." Needed to do an analysis on this group to see if their pain was controlled and their function was improved. The entire methodology of the study was flawed to exclude all possible patients that were benefitting from pain meds.

 

[lobelsteve]

https://www.painmedicinenews.com/Clinical-Pain-Medicine/Article/04-21/Buprenorphine-Shown-Superior-to-Oxycodone-for-Relieving-Chronic-Pain/63122?sub=&enl=true&dgid=&utm_source=enl&utm_content=1&utm_campaign=20210430&utm_medium=title

 

[Ferrismonk]

"We asked Mary Maston what she thought about Kolodny’s advice. She is an expert on kidney stone pain, having been born with a congenital disorder called medullary sponge kidney (MSK), which causes her kidneys to continually produce new stones."

Their "expert" against is a patient, not a physician.

"Maston would like to see an end to one-size-fits-all approaches to pain care and for providers to treat patients as individuals. One way to do that is with CYP450 testing, which looks for enzymes that determine how effective a medication will be in a patient. 'I personally think it's time to stop cramming all patients into convenient little boxes and start making CYP450 tests mandatory for anyone who suffers with chronic conditions. It would take the guesswork out of prescribing, prevent patient suffering, and eliminate the stigma, abuse and neglect of chronic pain patients by their providers,' she said."

A little off topic, but in my opinion, if you're a high-metabolizer of opiates, that's a reason to NOT give opiates, not give more.

Opioid vs Nonopioid Medications on Pain-Related Function

This randomized clinical trial compares the effects of opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects among Veterans Affairs patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain.

jamanetwork.com

"""
Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5])."""

He's totally wrong. APAP and NSAIDs are better than opioids.

Maybe for those 240, but not for MY patients. /s

 

[Laryngospasm]

If I do try opioids and they don’t respond to low dose initially I’m certainly not going to push higher and higher doses and stronger meds until I get a response.