chronic back pain opioids

1 in 4 Misuses Chronic Pain Meds

/ Thomas Cohn, MD

New research published in the journal PAIN suggests that approximately 20 to 30 percent of opioids prescribed for chronic pain are misused. Additionally, the current rate of opioids addiction hovers around 10 percent.

“On average, misuse was documented in approximately one out of four or five patients and addiction in approximately one out of ten or eleven patients,” who were prescribed pain pills as part of their treatment for chronic pain, said Dr. Kevin E. Vowles and colleagues. They added that the new findings provide “updated and expanded” estimates of the opioid problem in America.

Increased Prescriptions, Increased Addictions

Pain PillsTo see how increased opioid prescriptions have fueled pain pill addictions, researchers analyzed 38 reports to measure three separate opioid-related problems:

  • Misuse
  • Abuse
  • Addiction

Researchers examined documented cases of dependence, withdrawal and overdose to come to their conclusion. Opioid misuse was classified as “using opioids contrary to instructions, regardless of harmful or adverse effects.” After adjusting for variables, researchers concluded that between 21 and 29 percent of people who are prescribed opioids misuse them.

“If it is accurate that approximately one in four patients on opioids display patterns of opioid misuse, but not addiction, then perhaps more efficient targeting of treatment resources would be of benefit,” said Dr. Vowles.

As for opioid abuse, which is classified as continued opioid use with actual or potential harmful effects, researchers suggested that about 8 to 12 percent of patients abuse their medications.

Dr. Vowles and colleagues concluded by saying that physicians should seriously evaluate if a patient is a good candidate for an opioid prescription, as the dangers seem to be outweighing the benefits.

“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”

Related source: Medical News Today

Chronic Pain: Opioid Dangers Outweigh Benefits

/ Thomas Cohn, MD

Opioid DangersDoctors with the American Academy of Neurology say the dangers of opioid use for chronic pain management far outweigh the benefits.

“The evidence of harm is high, and the effectiveness is low,” said Dr. Gary Franklin, author of the AAN’s new policy statement.

Among other things, Dr. Franklin suggests that doctors shouldn’t be quick to prescribe certain opioids, especially in large amounts, and he recommends primary care doctors refer patients to specialists.

As a physician who specializes in chronic pain, I believe the second part of statement is the most important. Dr. Franklin suggests that the risks of poorly managed pain medications outweigh the risks for certain chronic conditions, but he believes they can be helpful for other conditions when partnered with an experienced pain management physician.

“It seems likely that, in the long run, the use of opioids chronically for most routine conditions, such as chronic low back pain, chronic headaches, or fibromyalgia, will not prove to be worth the risk,” Franklin said. “However, even for more severe conditions, such as destructive rheumatoid arthritis, sickle-cell disease, severe collagen disease, or severe neuropathic pain, prescribers need specific guidance on dosing, publicly available brief tools to effectively screen patients for risk, and guidance on how to monitor patients for early signs of severe adverse events, misuse, or opioid use disorder.”

I’ve been likening our bodies to cars in previous posts, and the second part of the quote reminds me of another automobile example. Let’s say you’ve got a major issue with your car, say, engine failure or a fried electrical system. Would you take your car to the auto shop down the street, or would you take it to a shop that specializes in fixing your exact car type? If you want the best results, you’d take your car to the garage that specializes in your brand, because odds are they’ve had more experience with the exact problem you’re dealing with, and are more qualified to fix the issue.

Your body should be no different. Visits to our primary care physicians are like oil changes and tire rotations – regular visits keep everything running smoothly and can help catch minor issues before they become major problems. When you have a big issue, like you need ACL reconstruction or treatment for acute destructive rheumatoid arthritis, you’re better off seeing the specialist.

In essence, Dr. Franklin isn’t saying we should abolish opioid use for pain management – we just need to make sure people know the risks and follow their doctor’s advice. And if you truly believe your chronic condition is worth seeking medical advice, don’t be afraid to consult with a chronic pain specialist.

Related source: MedPage Today