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.
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!
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.
Not really, he just substituted cigars.
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)
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
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.
This experience is but an initial reaction. It goes away in a few weeks of use.
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.
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.
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.
Yep. That's two-fold: Your body stops, or reduces its innate production, and one becomes psychologically less able to handle the pain.
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.
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.
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.
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