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Friday, June 1, 2012

My Belly, My Back, My Opioids

Chronic Abdominal Pain

Prescriptions for opioid painkillers to treat chronic abdominal pain more than doubled in the United States between 1997 and 2008, according to a new study.

"Very little evidence exists
to support the use of opioids
to treat chronic pain
that isn't cancer related,
and opioids are frequently misused
 and sometimes abused."

(Dr. Spencer Dorn, an assistant professor of medicine at the University of North Carolina Medical School at Chapel Hill, and colleagues, Clinical Gastroenterology and Hepatology, December 2011)

In fact, extended use of opioids can trigger other gastrointestinal symptoms such as nausea, vomiting and constipation, and may even worsen abdominal pain, he added.

Chronic abdominal pain is often incurable, which can make it challenging for doctors to help patients.

"Writing a prescription for a painkiller
may be the path of least resistance;
doing so may satisfy
the patient's demand for relief
and mitigate the clinician's
possible feelings of inadequacy," Dorn said.

Numerous factors have likely contributed to the sharp rise in the use of opioids to treat chronic abdominal pain, the researchers said.

These factors include a tendency
to generalize recommendations
for opioids' use in treating pain
and widespread direct-to-consumer advertising.

What does this study have to do with the growing rx drug abuse problem. Very slowly, read the words above once more. You can see this study contends the following:

1. Opioids are not recommended for treatment of abdominal pain that isn't cancer related.

2. Opioids are now misused and often abused.

3. Some doctors write prescriptions for opioids because of patients' demands.

4. Some doctors write prescriptions for opioids to avoid feeling inadequate when faced with patients who experience chronic pain. 

5. Widespread advertising by pharmaceutical companies aimed directly at consumers has created a myth that opioids are wonderful drugs to relieve many types of pain.

6. Much of the public has nos accepted "a general attitude" that opioids are good for treating many types of pain.

And, Chronic Back Pain

An estimated 15 to 20 percent of all Americans suffering from back pain at least once during a one-year period. A study (January 2004) by Duke lead researcher Xuemei Luo, Ph.D showed that back pain patients consume more than $90 billion annually in health-care expenses, with approximately $26 billion of that amount directly attributable to treating the back pain.

"Despite its widespread use for back pain, no study has examined at the national level the patterns and trends of opioid use among individuals with back pain," Luo continued. "While opioids are the most potent analgesic available, many physicians are reluctant to prescribe them because of their serious side effects, the potential for addiction and the possibility of drug tolerance."

Luo, a member of Duke's Center for Excellence in Surgical Outcomes, said:

"Just as importantly,
 no well-designed large-scale clinical trial
 has proven the efficacy of opioids
as a long-term treatment of back pain."

Among individual opioids, Luo found that the use of oxycodone doubled over the course of the four years studied.

Luo suspected that the increase
 maybe related to the introduction in 1996
 of a controlled-release form of the potent drug,
as well as an aggressive marketing campaign
by its manufacturer.

(Armen Hareyan, "Prescription Of Opioids For Back Pain Needs Improvement,", March 12 2005)

 Hello, Are You Listening?

I am continued to be amazed at how many people would rather listen to advertisements and a large group of uninformed, irresponsible physicians than to read the research and, quite frankly, to follow their own good common sense.

To blindly do so these days means running the risk of serious dependency, addiction, and death. No one should suffer with chronic pain; however, no one should find themselves seriously harmed by their own pain medication. When people tell me that the only rx addicts are criminals involved in the drug trade, I wonder how much a thorough, unbiased education would help these people see the truth.

Facing chronic pain, a patient could drink large amounts of alcohol, become dependent and then addicted to the point of eventually destroying his own life. Is this a treatment that alcohol manufacturers and physicians would go on the record and make this claim, "Alcoholism is an effective treatment for chronic abdominal or back pain"?

Folks, the love of money, ineffective controls of rx drugs, and biased information have fueled the rx epidemic. We must have more future investigations of safety and effectiveness of opioids in the U.S. And these investigations cannot be conducted by the pharmaceutical companies, or research firms and physicians they fund.

Surveys show that clinicians have a poor or limited understanding of the laws, regulations, and other policies that govern the prescribing, dispensing, or administration of controlled substances, including opioid analgesics. Little research has been conducted to determine the extent that clinicians’ knowledge of policies impacts healthcare practice and patient care. (Roger Chou and others, "Clinical Guidelines for the Use of Chroic Opioid Therapy in Chronic Noncancer Pain," The Journal of Pain, Vol 10, February 2009)

Educate yourselves, be sure your physician is educated about opioids, and support treatments that relieve pain, not increase it. I hope no one has to suffer -- no one. No one should suffer opioid addiction.

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