opioid prescription Archives - Minnesota Physical Medicine Blog

Every day in my practice I sit down with patients who strongly believe that opioids are the best course of action for their pain condition. While opioids certainly can play a crucial role as part of a comprehensive treatment plan, they definitely are not a stand alone option and are far from a perfect treatment as their problems are numerous and well known.

Pain is the physical and emotional response to certain sensory signals. In chronic pain, these signals are not necessarily any indication of danger or potential damage that may occur to the body. Opioids tend to modify the signals of pain, but often are not the most effective treatment and can have devastating secondary consequences. Due to the problems opioids may cause, most physicians are reluctant to prescribe these medications. A new study from the University of Minnesota is shining light on the inconsistencies in when opioids are prescribed.

Opioids In Today’s Society

Before I get into the crux of this blog, it’s worth reiterating that every patient who is interested in opioids is not simply trying to abuse their medications. Some are misinformed, and some truly believe they can help even if they won’t solve the true problem. However, there is a small subset who want medications for reasons other than to treat the underlying pain problem. Thirty years of practice has shown me all the tricks patients play to get medications prescribed. At times it is surprising the act some patients put on to get pain medications. Most physicians are aware of the issues, but still the charades occur.

The new study from the University of Minnesota shows that physicians tend to be vulnerable to over prescribing when they are tired, running late with their schedule, or at the end of the day. These are times when saying yes is easier than explaining no and finding an alternative strategy. This is especially important in acute pain situations when patients are especially prone to abuse and other solutions are appropriate. In some acute situations, short-term prescriptions are okay for several days, especially related to trauma or surgery when other medications for pain are not advisable. Awareness and prescription protocols by primary care providers and emergency rooms about opioids has led to a significant decrease in prescribing these medications. Other providers have been somewhat slower to adopt new habits for safe prescribing.

Opioids are only a small tool in the overall arsenal to treat pain. For many situations, opioids work poorly and are not very helpful. For some patients, opioids have so many problems that the risks of these medications are not even close to any benefit. The worst way to get these medications is to insist that they are the only thing that helps your pain. Usually that means that one does not want to work on other strategies that may be helpful. Unfortunately, some of the better treatments for pain are a struggle to implement because they take time, effort and money. Strategies like exercise, massage, relaxation and treating psychological issues are much more difficult then taking a pill. There’s no magic pill and it will take work, but you’ll be much better off for it.

Pain is difficult to manage, and pain specialists can help with a variety of options. Some problems are simple; most that end up with a pain specialist are very complex. There often is not a fix and most people will have to find a compromise and determine what they can manage and still function adequately. If you want help with your pain condition, reach out to Dr. Cohn’s office today.

A new report suggests that more than 90 percent of patients who suffer a nonfatal overdose on prescription opioid painkillers are prescribed more pills following the overdose.

In certain situations, opioids can and do help prevent some of the pain caused by chronic conditions, but they are prescribed far too often by doctors who don’t take the time to get to the underlying cause of pain. The findings confirm this unfortunate trend.

The research, published in the Annals of Internal Medicine, suggest that not enough is being done to help treat pain patients, and the patients are the ones suffering. According to the findings, 91 percent of pain patients who suffered an opioid-related nonfatal overdose were later prescribed more opioids, and opioid overdose survivors who continued to take medications were twice as likely to have another overdose within two years.

It’s saddening but not surprising that these findings have been published, especially when you consider that the Centers for Disease Control and Prevention recently published an article saying opioid induced overdoses have reached epidemic levels. According to the CDC overdose deaths from prescription opioids and heorin have increased 200 percent since 2000.

Opioid Epidemic

Lead researcher Mark LaRochelle of the Boston Medical Center hopes the findings will be a wake up call for doctors who prescribe a lot of opioids.

“The intent of this study is not to point fingers but rather use the results to motivate physicians, policy makers and researchers to improve how we identify and treat patients at risk of opioid-related harms before they occur.”

For their study, researchers examined insurance claim data of more than 50 million people who filed a claim between 1999 and 2010. After narrowing their list down to 3,000 people who had suffered an opioid-induced nonfatal overdose on their prescription, researchers checked to see what care the patients received after their near death experience. Shockingly, nearly all of the survivors continued to receive opioid painkiller prescriptions, and, of the patients who remained on painkillers, 70 percent of them were prescribed medications from the same doctor who prescribed them the medications they eventually overdosed on. According to researchers, those doctors may have continued prescribing opioids after the overdose because they may not have known about the overdose, or they still felt the benefits outweighed the potential downfalls. They also believe some doctors may be ill-equipped to be making opioid judgments after an overdose.

The CDC issued guidelines suggesting that physicians should cut back on opioid prescriptions after a nonfatal overdose. Instead, they should pursue physical therapy or non-opioid painkillers.

Related source: ZME Science