Study: Don't Avoid Opioids to Treat Back Pain

WMUR-TV ^ | March 14, 2003 | By Holly VanScoy

[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.

[neverdem]

"I would like to know more about how much he took and bought and what his medical condition is. Herniated disc is likely to merit a schedule II narcotic either of opiate nature or synthizised like Talwin, a muscle relaxer like Soma or Flexaril or Parafon-Forte and a kicker-anti-emitic like Promethiazine. Myself, I have found that any strong narcotic somewhat under the dialaudid or morphine sulfate level with the Promethiazine kicker works for me. However, folks with certain malignancies such as stomach or bone, need much much more."

My friend, the correct spelling is Promethazine, and it is in the class of drugs called phenthiazines. If you use it on a chronic daily basis for an anti-emetic, I would strongly suggest you find something else. Phenothiazines are notorius for their adverse effects on the nervous system when taken on a chronic basis. Bone up on their adverse effects, and go and tell your doc you want something else, Marinol if necessary.

[neverdem]

"Chiropractors are a solution rarely suggested by doctors. That's too bad, because often they are completely effective in relieving back pain without surgery or medication. Let me illustrate."

Osteopathic physicans are trained in manipulations about the same as chiropractors. They have the same medical privileges as a M.D. and are liciensed by the same folks. They have D.O. after their name, i.e. Doctor of Osteopathy. Some keep using manipulations, others others just do medicine or surgery because of the extra hassle getting re-imbursed for manipulation.

[neverdem]

"I hope the stomach holds out, because the Naproxen stuff is useless to me and makes me ill."

You might want to try one of the newer NSAIDs, i.e. the COX inhibitors, such as Bextra, Celebrex or Vioxx. They were developed to avoid the gastrointestinal problems of the earlier NSAIDs, although they still cause them. They are reported to cause less major bleeding episodes, IIRC.

[OldPossum]

You noted that senna is the laxative of choice at your hospice. Is this laxative a good choice for non-terminally-ill people who have to use it on a long-term basis?

I can understand that using a stimulant laxative (such as senna) cause the muscles which cause peristalsis to lose their "tone" and creates a problem all its own, i.e., a dependence on the laxative.

You are to be commended for caring for the terminally ill.

[Cold Heat]

, i.e. the COX inhibitors, such as Bextra, Celebrex or Vioxx.

The cost is the factor on these. I have not tried them, but frankly it is all I can do to afford the drugs that I get.

[neverdem]

phenthiazines = phenothiazines

Sorry about that.

[foolscap]

Yes, it's a good thing to avoid stimulants unless there is a real need for using them. A product I have seen used in nursing home for patients who do not have special medical problems is Fruit-eze. It's works great and doesn't taste too bad either. They have a site at www.fruit-eze.com

[texasbluebell]

Good to know. Thanks.

[neverdem]

"The cost is the factor on these. I have not tried them, but frankly it is all I can do to afford the drugs that I get."

Ask your doc, he probably has free samples of these COX inhibitors. Try the lowest doses first. Most folks take them only once a day. If you take a daily dose of aspirin for your ticker, then take the aspirin about an hour before you take any NSAID, or it interferes with the anti-platelet effect of the aspirin.

[Cold Heat]

Thanks for the advice. I will check it out.

[texasbluebell]

Arnica? How does it work? I might want to try it for the cramps in my arm and fingers. Does it work on symptoms caused by nerve injury/compression?

Well, I never was certain what was wrong with my neck, though it seemed to be a combination of things that must have caused this. I was thinking along the lines of pinched nerve, sprain, torn muscle from lifting weights without warming up, and falling asleep in bad positions, all of the above in combination.

Whatever the cause/causes, the pain was so severe that it would wake me at night, and I couldn't stand the thought of going on like that. I couldn't even turn my head while driving some days, and was worried about accidents because of that. This went on for just over a year...

Here's a link, not to say that this is the place to get it, look around, there are a number of sites where it's available on the net. Or if you live close enough to a homeopathic store, that's where I found it. (I don't think that includes something like GNC or similar but you could try calling around).

I was very fortunate that it worked for me, I'd recommend it to anyone before resorting to heavy drugs or surgery, which I was starting to consider. Within 3 days, the pain was substantially reduced, and by the time I finished the tube of gel, I hardly noticed it anymore, and that was only 3 weeks total time.

Here's the link which gives a description of Arniflora, which I understand is used by coaches for their athletes. (And it makes bruises go away in record time!) You can't go wrong trying it, it's only aout $6 or so.

Arniflora

[oreolady]

I am not going to repeat my long history here, but want to say a lot of the comments and impressions are WRONG~!!
After enduring 3 major spinal surgeries, and all manner of "therapies, treatment" as have others on this board, well know (and have tried)all options.


You would be very shocked to read some of the medical-spinal discussion boards, to see how knowledgable spinal patients, and those in chronic pain have become thanks to the interenet for information.
The STIGMA we (who are prescribed opoids) are subjected to is HORRIBLE.


Eveyone, maybe with intentions of "helping" say what they would or would not take, also their ridiculous reactions to temporary opoid usage. Talking to cats, indeed! Then the poster says (after being called on the subject) declares she always talks to cats!!
But she has given the impression that med users say and do wierd things, not accurate information tho.
Another poster is so inmtolerant that he won't even talk to s[pinal patients if they haven't comnsulted a choroiprator.
No one, unless you have been in that situation, can ever imagine what we endure, the years long search for a way to have a life.
I hurt badly when people I talk to state that they just "endure" the pain!!! And they will not consider some of the ugly treatments, not only surgery, but painful diagnosis tests, such as myleogram.


I have been on every one of these medications, and have NEVER been HIGH, or giggly, or any other symptom named here, except for constipation, headaches, and severe sweating.
Also, I just came oiff oxycontin in 1 week to switch to another medication, and the decrease from one med was no "withdrawal" problems.
Yes, it is extremely difficult to locate the right doctor that will sensibly treat and be aware of all medications and dosages. They are seldom so concerned as to take the time to do needed research. I am truly blessed to have such a doctor, altho it took me over 7 years to "find" him.

I beg you to think closely about unexperienced opinions, adn take it from us (constant) pain patients, give us a break, you will want the same if/when you become one of us!

[oreolady]

adn=and take it from us, (sorry)

[wardaddy]

I don't take anything DAILY except synthroid.

The drug in question is commonly combined with narcotics both as a kicker and anti-nausea

[Cold Heat]

when people I talk to state that they just "endure" the pain!!!

Yes, a very unpleasant option with devastating results.

I tried it for many years and paid for it with constant bouts of depression and alcohol consumption.

Since I found a good Dr. and got proper meds I have not had any depression in four years and alcohol is a thing of the past.(except for a occasional 2 beers during a BBQ)

Oxi-Contin and Oxy-codone drugs in general have restored my life to near normal.

I understand what happened to Rush. He knows what he did and with his nearly unlimited resources he should have managed the addiction that comes with the usage better. But, he chose to ignore the dangers of self medication in favor of freedom from all of the pain, all of the time.

I understand this and I do everything I can to refrain from using too much and from getting the regular dose so high that withdrawls become impossible without detox as the dose grows in size.

Rush admitted what he did. I just filled in some blanks here.

[stands2reason]

You're lucky to have a doctor who will treat your pain.

[oreolady]

Hey, strip, I am so glad you found the "right" doc, it is hard to do, with the predjudice and ill-formed opinions, especially and even more so now that the press has stepped in.
We will hear more on this subject, hopefully for people like you and me who are not afraid to speak up and inform people, we cannot hope to get any understanding.
All we want is to NOT be stigmatized for our medication needs, any more than a diabetic is, or any other kind of patient.
There are many, many, dangerous drugs out there that people take daily, without the media analysis!!!
Just look at all the silly "mood elevators", which are nothing but sedatives, people actually believe that your mood can be ELEVATED!!!How stupid!!!!!
BTW, I have NEVER gotten "HIGH", EVEN WHEN MY DOCTOR INCREASES MY DOSAGES!!!!!

[Cold Heat]

Yes, and I am worried about him with all this negativity.

I wonder how long it would take to find another or if I would need to do what Rush apparently did and purchase on the black market to take care of myself.

The VA has already been threatened to the point that they can no longer treat pain effectively.

[Cold Heat]

I have NEVER gotten "HIGH", EVEN WHEN MY DOCTOR INCREASES MY DOSAGES!!!!!

Yes, I have tried and tried to explain that fact with little success.

Rush did what he did to eliminate pain from his life. A noble goal IMO.

Unfortunately he went outside the loop. Either because he could not find a Dr. or because he did not listen to the one he had. Of this I am not sure.

[capocchio]

just do medicine or surgery because of the extra hassle getting re-imbursed for manipulation

What a wacky situation. The least intrusive of procedures and often the most immediately effective is not used because insurance won't pay for it.

No knife, no addiction, no wait solution is also no insurance. Give patient the choice, you'd think they'd pick instant relief. But the minute they find out they have to pay for it themselves, they opt for only what insurance will cover.

Talk about sheeple. Talk about addiction. Talk about stupidity. Someone will spend thousands on cars or stereos or vacations or beauty spas, but nothing on their own health if insurance won't cover it. It might make sense if the cost of manipulation were great, but it's not. It's usually minimal. Maybe they deserve to be in pain.