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Study: Don't Avoid Opioids to Treat Back Pain
WMUR-TV ^ | March 14, 2003 | By Holly VanScoy

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.


TOPICS: Culture/Society; Editorial; Extended News; Front Page News; Miscellaneous; News/Current Events; Politics/Elections
KEYWORDS: addiction; backpain; medicine; opioids; rushlimbaugh
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To: Wisconsin
This was prescribed for me during the last and most painful part of radiation therapy for cancer. It seemed to relieve pain, but it made you care less about it.

The most interesting and scariest thing about it occured while I was reading. I would read a paragraph and then discover the second paragraph I was reading dealt with an entirely different subject. My mind was creating the second paragraph.

I then watched more television (ugh) and even more interesting plots developed than the ones being presented.

Unfortunately, after the radiation was concluded I occasionaly would take one if I was having any difficulty, but was able to give up the drug completely. It wasn't easy.

In respect to Rush's addiction, it's difficult for those who have never suffered excruciting pain to understand how one can get started using these medications and then continue using them because a person "feels" they still need the support.

I admire Rush, who has served as a beacon of light to myself and millions of others over the extremely difficult Clinton years.

I'll be glad when he returns, especially when it will deny the leftists in this country their glee!

61 posted on 10/13/2003 3:56:31 AM PDT by JesseHousman (Execute Mumia Abu-Jamal)
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To: Plutarch
I sincerely hope that those people who favor and impliment the government policies that make it hard for sufferers of severe pain to get apropriate and useful pain killing drugs will die screaming.

62 posted on 10/13/2003 4:20:18 AM PDT by Rifleman
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To: AlwaysLurking
THANK you for posting this article; and honest and frank discussion is precisely what is needed. I knew this was a leftist attack on Rush the minute it was launched.

I've had the back problems, and know that you cannot function with that kind of pain. I've been there, on pain meds round the clock, and know what it is like to not be able to do the simplest things.

Most back surgeries are bungled. The pain is the worst you could ever experience, and going back into surgery is not an option, for it can leave you worse than you were when you went into the operating room! This is the one way for these people to live functioning lives and continue to contribute and go on.

Rush may not be able to quit these drugs, and not because he is weak, but because the pain can be so incapacitating. You can bet the farm that if a leftist had this kind of pain going on, they would be on these drugs in a heartbeat, and never stop them, AND they would be protected by their own lying cohorts.

We need to stand by Rush, and become advocates of using thees drugs in ways that help people -- him being a prime example. We must not let the left win on this one, for it is wrong. Just ask the doctors in the field.

63 posted on 10/13/2003 4:34:13 AM PDT by Constitution1st
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To: _Jim
SOUNDS like cigarettes ... Rush licked that habit once ...

Not really, he just substituted cigars.

64 posted on 10/13/2003 5:13:33 AM PDT by VRWC_minion (Opinions posted on Free Republic are those of the individual posters and most are right)
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To: AlwaysLurking
I broke two vertebras in my back 13 years ago after falling on an icy porch. Sciatica has been my companion ever since. Some good days, some bad days. Can't travel far before the pain in my leg becomes severe. Exercise seems to help. Told my doctor about it. He said welcome to the club. He has it too and takes advil for it. I don't take much and don't have the pain that some here discuss but it is very debilitating for certain. Takes all the "fire" out living.
65 posted on 10/13/2003 6:20:28 AM PDT by RichardW
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To: All
True confession time: Has anyone tried "medicinal marijuana" for pain?
66 posted on 10/13/2003 6:31:32 AM PDT by AppyPappy (If You're Not A Part Of The Solution, There's Good Money To Be Made In Prolonging The Problem.)
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To: wardaddy
Why buy this ALLEGED huge doses of hydrocodone and oxycodone which from my experience are not quite up to the Class A narcotics level for severe pain....

I believe this is more about the stigma of addiction then a inability to obtain the drug legally, but both reasons are likely involved.

Because of the way this type of drug works, (the more you take, the less pain you have) it can lead to overuse very quickly and a DR. will see this fact. The patient knows and fears that the Dr. will see it and there ya go! (black market buy if you have the money and connections)

This is addictive behavior and Rush is certainly guilty of that.

However, on the subject of quantities, he did say that there were many inaccuracies and distortions in the media stories and I would guess that the maid is trying to make Rush her only customer. This would mitigate her legal difficulties. (chump charge)

67 posted on 10/13/2003 6:51:12 AM PDT by Cold Heat ("It is easier for an ass to succeed in that trade than any other." [Samuel Clemens, on lawyers])
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To: L`enn
I work with hospice and spend much of my time with people taking high dose of morphine. The best laxative we have found for dealing with constipation from opiates is senna. One needs to regulate their does themselves. For example an average dose for a normal person is one or two per day. For people on opiates the dose can go much higher. I have one patient who takes 12 per day. It all depends on your body. Start low and work up to see where you are at. Use it daily.

The second thing to try is bisacodyl suppositories. They are available over the counter or in enema form from Fleets. The bisacodyl gets things moving. It works very well but can cause cramps for some.

The main thing is don't let it go for too long. If one skips a day without a BM attack the problem on the second usually with the bisacodyl. Don't wait the problem will just get worse.

I am sure others in the medical field will have suggestion. This is just been my experience from the people I have worked with and have found it very successful

68 posted on 10/13/2003 6:57:29 AM PDT by foolscap
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To: libbylu
I get the percocets at a discount through the VA. They do not prescribe the (tylenol less) drugs and I was not aware that they existed.

The Oxy-Contin is the best thing that I have found due to the time span of relief, but I find that I need the ibuprofen to help with endurance with walking (cane assisted)or any other activity. I will ask my private DR. about the others, but I believe the combo that I use works well.

As to the stomach risk, I am aware and I do not use the Ibuprofen around the clock. Most days I only use it mornings and before bed.

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

69 posted on 10/13/2003 7:02:01 AM PDT by Cold Heat ("It is easier for an ass to succeed in that trade than any other." [Samuel Clemens, on lawyers])
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To: wardaddy
It was the only time I've ever tried an alternative med, and I was pleasantly surprised that it worked, in fact, didn't expect it to. I couldn't have taken it if that pain had continued much longer.
70 posted on 10/13/2003 7:04:14 AM PDT by texasbluebell
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To: dix
Hydrocodone gives you an incredible sense of well-being

This experience is but an initial reaction. It goes away in a few weeks of use.

71 posted on 10/13/2003 7:06:17 AM PDT by Cold Heat ("It is easier for an ass to succeed in that trade than any other." [Samuel Clemens, on lawyers])
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To: AlwaysLurking
I hope the situation with Rush opens a good and honest discussion in this country on how to help people in pain.

About 5 years ago, I began to see in the literature a sizable body of work that showed that it required truly remarkable amounts of pain-killers to OD if one is actually in pain. Basically, as long as you didn't use other medications, drink, or otherwise activate synergistic effects, and you actually needed the pain-killing effect, very large doses were not lethal. Conversely, it was implied that if you took X amount for pain, and that a short while later the base level of pain (rapidly)went away, you could OD on the same dose because the pain level dropped. This effect was made more severe because of the body's rapidly growing resistant to such things by cutting back on its own natural supply (Endorphins and enkephalins), which encourages ever-increasing dosages.

72 posted on 10/13/2003 7:38:51 AM PDT by lepton
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To: wirestripper
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)

Because basic brain chemistry has been so thoroughly messed up, it could well be lethal to just quit cold-turkey.

Opiates work because they duplicate the effects of internally created opiates such as endorphins (Endorphins = endogenous morphines - Morphines made within your body) and bonds to receptors, reducing pain. As you add opiods to your system, your body reduces the amount of endorphins and enkephalins that it creates. This compensation happens very rapidly, and when the opids are no longer administered/taken, the brain chemistry is thrown quite out of whack for a bit.

73 posted on 10/13/2003 7:45:34 AM PDT by lepton
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To: eddie willers
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."

That depends upon whether he was using them recreationally, or if he was using them to compensate for a medical problem. There are several goofy things with the story as it came out, and we may yet learn that only bits and pieces were correct - but if he were taking what was reported himself, and not for pain, he would be quite dead.

74 posted on 10/13/2003 7:50:17 AM PDT by lepton
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To: goody2shooz
It appears that the more one uses painkillers, the lower drops one's threshold to pain.

Yep. That's two-fold: Your body stops, or reduces its innate production, and one becomes psychologically less able to handle the pain.

75 posted on 10/13/2003 7:55:55 AM PDT by lepton
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To: Wisconsin
About the third day I was talking to the cat -- and he was talking back. We discussed medieval stone work...

Cool!
76 posted on 10/13/2003 8:00:09 AM PDT by Dasaji (Today's witchcraft is tomorrow's technology.)
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To: wirestripper
but as I came to accept my condition, I accepted the addiction as a side effect and not a disease.

That is very profound, WS. My husband is on the brink of having to go to stronger pain management meds than what's available over the counter (he's not even 40) for back pain and arthritis in his hands and knees. The man gets up every day and goes to work in severe pain - and he goes to sleep with it every night only to wake up to it again and start all over. Tylenol, Aleve, Aspirin barely touch it. A tall vodka and lemonade almost takes the edge off. We've discussed going onto bigger and better pain management drugs, but that nasty word "addiction" (potential) comes into play - even if it's taken just to get a good night's sleep (which rarely happens). Your post has inspired me to perceive this as more of a kindness than social stigma - thank you.
77 posted on 10/13/2003 8:14:56 AM PDT by Dasaji (Today's witchcraft is tomorrow's technology.)
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To: Constitution1st
Most back surgeries are bungled.

Actually, there's a sizable amount of evidence that back surgery is at least half well-intentioned quackery. When a doctor looks at the spinal defects apparent in an X-ray, there is generally not enough known about the details (and wide enough variation between people) that he's more or less guessing.

While not my only source for this opinion, John Stossel had a good story on this a few years ago: Demonstrate that you have back-pain, give the doctor an X-Ray, and if you've got microfractures or an abnormal shape, he'll find a defect to associate with the pain - yet there is little evidence that he'll reliably be actually correct. Only in severe degenerative cases is there a high correlation.

78 posted on 10/13/2003 8:15:49 AM PDT by lepton
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To: Dasaji
Your post has inspired me to perceive this as more of a kindness than social stigma - thank you.

No........, Thank YOU!

The problem is to get the rest of society to understand the intricacies of this situation.

The options are so limited that without the medications, a typical and normal person will fall into a cycle of depression and often with terrible results.

It comes down to a life decision and Dr's must understand this as well.

79 posted on 10/13/2003 8:30:28 AM PDT by Cold Heat ("It is easier for an ass to succeed in that trade than any other." [Samuel Clemens, on lawyers])
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To: AlwaysLurking
I was on morphine while waiting for back surgery on a couple of herniated discs. It was a miracle drug and allowed me to function during the period of time it was effective. I was limited to morphine four times a day and it only worked for about 4 hours. When I tried to put pressure on my right foot, incredible pain would rack my body instantly sending me to the floor. Fortunately, the left leg did not experience this problem.

After surgery there was immediate relief. No one had talked to me about slowly getting off the morphine, so I stopped on the third day after surgery and went through a really bad spell until I learned what the problem was from my more knowledgeable wife. So I took two weeks to slowly phase it out with no further problems, excepting the constipation.

If you have never had such pain, it might be easy to think that addiction could not happen. But believe me, when the pain gets great you will reach for anything. I was initially afraid of morphine and resisted its use, but it did not take long for me to realize that constant pain was no way to live. I wish Rush well in his recovery.

80 posted on 10/13/2003 8:42:08 AM PDT by Grampa7030
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