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Posted on 10/12/2003 7:34:05 PM PDT by AlwaysLurking
Study: Don't Avoid Opioids to Treat Back Pain
By Holly VanScoy HealthScoutNews Reporter
(HealthScoutNews) -- Doctors and pharmacists tend to avoid prescribing them, patients are afraid of becoming addicted to them, and government officials are concerned about their abuse. It's little wonder that opioids have acquired something of an unsavory reputation in medicine. But is it all deserved?
A new study suggests it's a mistake to ignore the potential value of these powerful pain relievers for chronic conditions, including musculoskeletal pain and lower back pain.
There's evidence that opioids such as morphine, oxycodone, and fentanyl can help and should be the treatment of choice for some patients, says Dr. J.D. Bartleson, a Mayo Clinic neurologist and lead author of the study. It appears in the latest issue of the journal Pain Medicine.
"The prejudice against the use of analgesic opioids is unfortunate," Bartleson explains. "Especially since it results in their being underutilized in situations where they can contribute to improving patient outcomes. Opioids can provide significant relief for patients experiencing severe pain. I believe physicians and patients should be considering them more often than they presently do, including use in the management of chronic, nonmalignant pain."
Bartleson bases his conclusion on extensive analysis of all studies of opioid use in the treatment of chronic lower back pain. Despite longstanding controversies over opioid misuse and potential dependence, Bartleson found there is a place for their carefully considered and closely monitored use in treating this persistent, debilitating condition. In particular, he says, opioid use may provide a better alternative than back surgery and other pain medications for many patients whose lower back pain is persistent.
"Fewer than half of all back surgeries are successful in relieving chronic back pain," Bartleson says. "Other medicines for pain -- including aspirin and acetaminophen -- can cause permanent adverse effects. Opioids have been demonstrated to provide pain relief, without long-term side effects."
John Giglio, executive director of the American Pain Foundation, concurs. He adds the recent controversy over the opioid OxyContin has further muddied the waters over the benefits of this entire class of prescription medications.
"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says. "Even where there is no arrest, no indictment, no evidence of physician or pharmacist wrongdoing, an investigation sends a strong negative ripple through the medical community."
Giglio says chronic back pain is only one of the conditions for which negative publicity has overshadowed opioids' legitimate and proven medical benefit. Even in the treatment of serious malignant conditions, doctors and patients tend to shy away from the powerful drugs.
"In a recent survey of cancer specialists in California, for example, only about 60 percent of the oncologists reported being certified to prescribe opioids," Giglio says. "Of these, only 40 percent had ever done so -- which means that only one in four physicians specializing in cancer treatment in California are presently using the most powerful painkillers available in their practice."
Giglio and Bartleson agree that additional, longer-term and better-designed studies are needed to study how opioids can be best used in medical care.
Although Bartleson now counts himself among believers in opioids' benefits in the treatment of chronic back pain, he doesn't advocate their use for every back pain patient. "Opioids definitely have a role to play," Bartleson says. "But a physician has to make sure that whatever treatment is pursued is the best for the individual patient. Opioids aren't for everyone."
Bartleson adds that, more than anything else, his study points out the need for additional well-designed studies on treating back pain, including the role opioids can legitimately play in such treatment.
Copyright © 2002 ScoutNews, LLC. All rights reserved.
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patients are afraid of becoming addicted to them, and government officials are concerned about their abuse.SOUNDS like cigarettes ... Rush licked that habit once ...
Hi, we're from the government...we're here to help you. Pfah!
Hell no!
All this fuss is making it even harder to be treated for chronic pain.
I have to deal with this mess on a regular basis.
I use Oxy-codone (percocet) and Oxi-Contin on a 24 hr basis for pain control.
Without them I cannot function in any normal way and my life would not be worth a 25 cent bullet to the head.
As a result of the drugs, I am addicted to them. I control my intake, but you tend to get used to the drug and the effect slowly lessens and you need more.
No body who needs these drugs takes them to get high. That would be abuse.
People who take them for chronic pain on a 24 hr basis get addicted. You cannot prevent it and the alternative is to vegitate and get a case of severe depression.
Rush has apparently let things get out of control and has admitted this. However, it is so easy to have this happen and with his resources, he has gotten the dose so high that he cannot get through the with drawls on his own. (with drawls are very uncomfortable and last for days)
He has made an error in judgement, but his addiction came as a normal side effect. His bank account and desire to keep his show going and on the air has caused him to use more than he should, but not to get high.
He did it to function normally and pain free.
It happened because there is no other option for pain relief.
If Rush has to retire because of this, it will not be because of the drugs.
It will be because of the lack of them and the resulting pain that he will have to endure.
I will say and few words in my prayer tonight for him. I want him to understand that he did not do anything wrong by taking a needed drug so that he could live as normal a life as he could. His mistake was to self medicate to such a degree.
This is absolutely true and on target.
The Veterans Admin, for example, will not provide Oxy-Contin, but they will provide morphine.
Talk about medical correctness.
I take Oxycontin as well, and my first thought was,"How will he make it, if he still hurts?"
I hope he didn't break the law to get relief, but it makes one wonder. If Rush could not have his pain adequately, how can an average citizen hope to get help?
Also, these Oxy-Conti stories are making it difficult to find a provider for the drug.
Without the 12hr time release version of Oxy-codone, I would be forced to take percocets all day long and the Tylenol would likely cause liver damages over time.
I wish they would combine it with someting like Ibuprophen.
It would be much better for me.
The Oxy-Contin idea is great for me. I take Ibuprophen (4 every four hrs) on top of it and it helps greatly.
It must be pretty painfull if he opted for surgery. I understang the surgery did not help and a back usually is worse when trying to sleep or sit, as opposed to standing for most folks that I have talked to.
The drug has a horrible reputation and doctors are terrified to prescribe it. This leads to countless people suffering needlessly. Used properly, OxyContin is a wonder drug.
When the Rush thing first broke, most defenders here were saying, "Impossible....he couldn't work as hard and as well as he has if he were taking all those drugs."
I was thinking, "No....it was the drugs that allowed him to be so productive."
We have just GOT to get over this knee-jerk reaction to drugs.
(and as we baby boomers, who have always gotten what we have wanted, age and become infirmed.... it may well happen)
That's not an easy thing to do. My mother has had persistent hip pain for the last 15 years. She toughs it out...because she can.
Pain is subjective. We tend to think that everyone feels the same level of pain we experience. That's not the case in reality. Imagine your worse day and double the pain the felt that day. Would you be willing to live the rest of your life like that?
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