Ibuprofen and Naproxen For Chronic Pain

November 16, 2016 / Thomas Cohn, MD

New findings on the success of certain anti-inflammatory drugs uncovered that ibuprofen may not be the best option for individuals with certain types of chronic pain.

The study took a look at the success of a couple of different anti-inflammatory medications – ibuprofen, naproxen and celecoxib – in managing chronic pain caused by inflammation. Researchers tracked thousands of patients who took one of the three medications for pain management over the course of roughly two years. The conditions being treated were most often osteoarthritis and rheumatoid arthritis.

Anti-Inflammatory Drug Findings

At the outset, researchers expected individuals in the celecoxib group would have slightly more adverse heart events, as the drug and similar drugs were believed to be linked to potential heart problems. However, not only was that not the case in this study, celecoxib actually outperformed the other two medications.

Researchers found that celecoxib did not cause more heart attacks, strokes or deaths compared to ibuprofen, and it actually exhibited lower rates of kidney problems.

“In almost every measure, ibuprofen looks worse, naproxen is intermediate and celecoxib is the best,” the study’s lead author wrote.

However, researchers cautioned against simply switching off of ibuprofen simply because of the study results. If you don’t have a preexisting heart condition or you don’t take ibuprofen on a regular basis, you shouldn’t have to worry about additional heart risks. If your current regimen is working, then discuss any potential changes with your doctor before switching up your routine.

Additionally, researchers noted that the study did not evaluate celecoxib’s effectiveness at treating chronic pain itself. Instead, they were only examining at whether or not specific anti-inflammatory drugs came with additional health risks.

How Placebo Pills Are Helping Patients With Chronic Pain

October 27, 2016 / Thomas Cohn, MD

New research suggests that knowingly taking placebo pills may help chronic pain sufferers find some pain relief.

Conventional wisdom suggests that the placebo effect should only work if the patient believes they are taking a medication with an active ingredient, but the new study suggests that may not be the case.

“These findings turn our understanding of the placebo effect on its head,” said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. “This new research demonstrates that the placebo effect is not necessarily elicited by patients’ conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship — even if you know it’s a placebo — is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms.”

Placebo Study

For the study, researchers recruited 97 individuals with chronic low back pain and split them into two groups. Both groups watched a 15-minute video explaining the placebo effect, then one group continued their normal treatment, while the other group took daily placebo pills that were stored in a container marked “placebo pills” that clearly stated that they had no active ingredient. Both groups continued their specific treatment options for three weeks.

At the end of the three week period, patients in the placebo pill group reported 30 percent reductions in typical and maximum pain, while those in the treatment as usual group experienced 9 and 16 percent reductions respectively. Individuals in the placebo group also reported a 29 percent drop in pain-related disability, while those in the treatment as usual group did not report improvement in that measure.

“Our findings demonstrate the placebo effect can be elicited without deception,” said lead author, Claudia Carvalho, PhD. “Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered.”

However, Dr. Carvalho cautioned that the placebo effect may only provide mild relief for patients with undiagnosed chronic back pain, and that patients with specific conditions like herniated discs or pinched nerves will not experience similar results.

“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” he said. “It’s not a cure-all, but it makes people feel better, for sure. Our lab is saying you can’t throw the placebo into the trash can. It has clinical meaning, it’s statically significant, and it relieves patients. It’s essential to what medicine means.”

Manipulating Statistics About Chronic Pain

June 27, 2016 / Thomas Cohn, MD

A newspaper headline read this week, “1 in 3 Medicare Patients took Opioids” in the last year. Is that as big a deal as the headline made it out to be? Probably not. If one starts to think about the article and read the whole story, it becomes ridiculous. The study being cited actually reports that 1 in 3 Medicare recipients overall received at least one prescription for an opioid medication in the last year. The article and the study indicated this was a major problem.

Some facts should be thought about when analyzing such a study. First, one in three people suffers from chronic pain. Further, chronic pain tends to be more common in the elderly and disabled, the very population that has Medicare. One prescription within a year’s time is probably not significant. Many people have significant medical procedures within one year, including dental procedures, numerous outpatient surgeries, or even painful diagnostic studies. Others have injuries that may be extremely painful for several days. The common thread is that all these things are appropriate for short-term opioid use to control pain. Obtaining one prescription within a year for a third of all Medicare patients would probably be very normal.

Interpreting The Stats

The focus of the study and the article is to emphasize how bad and problematic are opioids. If one stops and thinks for a second, making that conclusion on the basis of “1 in 3 Medicare patients have received a prescription for opioids in one year” is terrible. Acute pain is exactly what opioids are best used to treat, especially for just a few days. It would not be surprising to find out that 1 in 3 Medicare patients had a significant medical procedure for which an opioid was prescribed.

A more devastating fact should be that 1 in 3 people suffer from chronic pain. The causes of pain are extremely varied. The headlines of the paper are all about addiction. There are very few about how widespread pain is a problem. The big alarm is about death related to drug abuse. Addicts are obtaining billions of dollars for further treatment and research from the government. There are no headlines about how people struggle day to day with dealing with pain and still trying to continue with life.

Addiction to opioids and the increases in deaths is a problem. The solution in reality is probably to treat the true problem, which is the pain. Better pain medications that are not addictive definitely are needed. Research in the basic science of pain and how to prevent it is needed even more.

1 in 4 Misuses Chronic Pain Meds

April 15, 2015 / 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

To 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