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.
It is possible that you may have an underlying psychiatric disorder? I am not trying to be disrespectful at all, but just trying to ascertain if there may be something else going on.
Oxycodone is an Mu (endorphin receptor) agonist, and is not a hallucinogen.
If you took the Oxycodone with LSD, then the above scenario is quite possible. However, what you experienced is an extremely bizarre reaction to this particular pain medication.
It is interesting to note that "hallucinations" are listed as a side effect to aspirin. Do you get this reaction to all pain medications, or just the oxycodone?
I got off it that evening. The pain was less scary. Besides the oxycodone constipates you.
This is interesting. You could possible ave an allergy to the medication. What you describe is very atypical, except the constipation. Chronic opiod users often need to take a mild laxative. The majority of the body's Mu receptors actually are in the intestines. Over the counter "Immodium AD" is an opiod, actually a derivative of Demerol. This is why it is so effective at helping diarreah.
Only small amount crosses the blood/brain barrier, however, so few people abuse Immodium.
Oxycodone. Constipating, defintely. Talking cats ... I suppose there is a first time for everything.
Not always. It may be interesting to note that these drugs are being re-investigated for use in patients with severe depression and anxiety. Opiates used to be the drug of choice for these ailments before 1900, and they are making a comeback.
It turns out that not only are they more effective, but they are much safer than modern anti-depressants such as Prozac, Zoloft, and Paxil which have a similar mechanism of action to the drug Ecstacy, and have a long-term neurotoxic profile.
So, for some chronically depressed people, that "high" would actually be considered a "normal" mood for non-depressed individuals.
Not all opiod use for it's psychologic effects is considered abuse.
Of course, most everyone would agree that taking a quantity to the point were you are nodding out and non-functional is of benefit to nobody ... but mild "euphoria" from low to moderate doses is actually as beneficial to non-functional depressed adults, as it is to non-functional pysical pain inflicted individuals.
Pain is not always only physical.
The fact that pain killers are linked to a cure for depression is not a surprise to me.
The euphoric effects go away after a few weeks of use. It is of no consequence in the addiction to the drug. They alter the brain chemistry by replacing the body's ability to produce endorphins.(natural pain killers)
Wow I bet that line of investigation doesn't get much support from the drug industry. Taking away their expensive best sellers with side effects for dirt cheap narcotics with a well known profile - That'll make the whole drug industry cranky:)
The theory is that there may be deficiency in the endogenous opiod system of depressed people.
Just as some people do not produce enough (or too much) dopamine, serotonin, insulin, etc ... it would be naive to think that nobody has a deficient opiod modulation system. An overabundance of Mu receptors, or a low level of natural endorphin results in dysphoria (depression). What these opiods do is simply bring up the level of endorphins in a person's body that a non-deficient person would be expected to have.
When the drugs are withdrawn, the person returns to a depressed state. This is not necessarily from withdrawl (although most doctors will call it that), it may simply be a ruturn to the originally deficient state that the patient was in before they received the supplemental Mu agonists. If someone is deficient to begin with, the opiods don't necessarily "replace" the body's ability to produce endorphins (since little is being produced in the first place), rather, they bring the levels up to normal.
At least that is the theory, and from all accounts it would seem perfectly logical.
You hit the nail squarly on the head. The medical community has known how to successfully treat depression and anxiety, both acute and chronic ... for over 100 years with dirt-cheap compounds.
There is no money to be made in this, however. So the natural reaction is to vilify the cheap, effective drugs ... and tout the questionable merits of the extremely profitable, questionaly effective, and more dangerous "new" drugs.
This is no secret. Most older psychiatrists will readily admit that they would rather give morphine to their recalcitrant depressed patients than Prozac. The DEA and AMA will not let them, however.
When you cross the i's and dot the t's, it's all about the money.
The opiates are being re-explored now because they have found some expensive and profitable ones (such as Buprenorphine). When the patents expire on those, they will be declared dangerous and harmful until a new patented opiate is found.
Rinse and repeat.
The Pharmacuetical Industry/FDA relationship has always been one of questionable integrity.
Yes, they do.........
I have a blood/liver function test done every three to four months.
I am aware of the interactions. Diphenhydramine(Benidryl) Is one of the buggers you need to watch out for. A little is ok, but too much and autonomic breathing can cease.
Yeah, and it probably helped his golf game too.
Richard W.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.