dangers of opioids Archives - Minnesota Physical Medicine Blog

Doctors 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

The recent death of actor Philip Seymour Hoffman has brought to the forefront the issue of narcotic overdose. Many of the famous actors who have died of medication overdose have done so with a whole cocktail of drugs found in their system. Many have overdosed on a combination of multiple prescription medications, street drugs and alcohol. The mixture of drugs is especially lethal, since the effect of the mixture makes many drugs more toxic. A very common mixture found in overdose cases is the combination of opioid/narcotic and benzodiazepine. The source of these medications is most often the primary care provider.

Opioids and Benzodiazepines

Opioids have a very legitimate use for the management of pain. The prescription of these medications for acute pain on a very short-term basis by primary care providers is definitely appropriate. Once pain becomes chronic, pain management becomes much more complex, and the prescription of opioid medications should be in consultation with a trained pain physician. Since there are many advanced treatments for pain, the inclusion of a pain physician will reduce the over-prescribing of opioids. Furthermore, pain physicians will be able to better monitor appropriate medication use and determine early when the medications are not advisable.

Benzodiazepines are medications used for anxiety. Short-term use of these medications for anxiety is reasonable if prescribed by a pain physician. Anxiety and depression are closely related, and if the patient is depressed, treating the condition with an anxiety medication will not help resolve the feeling of depression. Ongoing anxiety is usually a sign that the patient is depressed, and a physician should prescribe a depression medication and not a benzodiazepine.

Pain and Depression

In the brain, the centers for pain and depression are next to each other and they interact with one another. Significant pain will cause stimulation in the area that controls your mood, thus, a patient with chronic pain will often be depressed. A primary care provider will often treat individual symptoms through a combination of opioids and benzodiazepines, which is safe as long as they are taken in the recommended amount. A patient may not realize the danger of these medications and may overdose if they take too much in a short period of time or in combination with other drugs.

The other main issue is that these medications are, for the most part, widely prescribed. These medications are available in the public, and they are being traded and sold, which opens them up for abuse. A person with an addiction has easy access to these medications either legally or on the street. Better management of patients who actually need these medications will greatly reduce the amount of medication on the street. Better education of all medical providers on pain management will also help. Experts trained in recognizing pain and depression symptoms can help decrease the amount of excessive or unnecessary pills that flood the market.

The more we know, the more we can do to help keep people safe.