UK Healthcare – Chronic Pain With Opioids

The following article was posted on the U.S. Health Care website on April 7, 2016, Source of study:

              Some best advices for Treating 

                  Chronic Pain With Opioids

 April 7, 2016

New Advice for Treating Chronic Pain With Opioids
Controversy over new guidelines from the Centers for Disease Control and Prevention regarding opioids have left many people concerned that they won’t be able to get prescription painkillers such as Oxycontin, Percocet, and Vicodin when they need them.

“There’s a lot of misinformation out there,” says Roger Chou, M.D., associate professor of medicine at the Oregon Health & Science University in Portland and one of the authors of the CDC guidelines. “The truth is that the guidelines acknowledge that opioids are essential to alleviate severe short-term pain and for use in palliative care.” They also “make room for using opioids as part of a comprehensive treatment strategy for chronic pain,” he says. “The drugs just shouldn’t be your doctor’s first or only treatment option.”

That principle lies at the heart of advice from several major medical organizations, including the American Pain Society, the American Academy of Pain Medicine, the American Society of Intervention Pain Physicians, the American College of Occupational and Environmental Medicine. And the American Society of Anesthesiologists recently issued guidelines about when opioids should, and shouldn’t, be used to treat chronic pain.

The CDC is weighing in now because too many doctors are ignoring those recommendations. In 2014, U.S. healthcare providers wrote more than 244 million prescriptions for opioids according to IMS Health—enough to give almost every adult in America a bottle of pills. The new CDC guidelines target primary-care doctors, a group responsible for half of all opioid prescribing in the U.S.

“More than 40 Americans die each day from prescription drug overdoses,” says CDC Director Tom Frieden, M.D., M.P.H. “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic.”

A Poor Solution for Chronic Pain
Opioids cause changes in your brain and body that makes them a poor solution for many types ofchronic pain according to Consumer Reports’ Medical Director Orly Avitzur, M.D. “The drugs may relieve pain initially, but most people quickly develop a tolerance to them, meaning it takes progressively higher doses to get the same effect,” she says. “Eventually, very high doses may not work well.”

And the longer you take opioids, especially at high doses, the greater the risks of serious side effects, including addiction, overdose, and death—even if you use the drugs legitimately to combat pain.

If the drugs aren’t helping, or are causing serious side effects, it can be difficult to stop taking them says Avitzur. While the majority of people who take opioids to treat pain don’t become addicted, nearly everyone who takes the drugs longer than a couple of weeks or so becomes dependent on them. Stopping abruptly can lead to withdrawal symptoms, including anxiety, insomnia, and worsening pain.

Some people who take opioids for chronic pain arrive at a stable dose that they find helps their symptoms, says Chou. “But you want to explore all the other safer options available to you before heading down that road,” he says. “Research shows that people who start taking an opioid for chronic pain often never come off the drugs.

The CDC guidelines consist of 12 recommendations to primary-care providers regarding opioid prescribing. We’ve summarized the key advice below.

  • Don’t overtreat short-term pain. After surgery or an injury most people can transition to saferover-the-counter painkillers within three days; few people need powerful prescription painkillers for more than a week. If you take opioids longer than that, your body can become dependent on them. Short-acting opioids are generally safer than potent, extended-release versions, which stay in the body longer and increase the risk of overdose.
  • Try other measures first for chronic pain. Make nondrug approaches the centerpiece of your treatment plan. “Substantial evidence supports the effectiveness of treatments such as exercise, cognitive behavior therapy, and rehabilitation programs in helping feel better without the deadly harms we see with opioids,” says Chou. For some types of pain such as fibromyalgia, migraines, or nerve pain, other prescription medications may work just as well or better than opioids and are clearly safer. And many people find that an over-the-counter pain reliever such as acetaminophen (Tylenol and generic), ibuprofen (Advil and generic), or naproxen (Aleve and generic) provides sufficient relief, especially when combined with nondrug approaches.
  • Start low and go slow. If you wind up taking opioids for long-term pain, the CDC advises starting on the lowest effective dose of a short-acting medication, increasing the dose cautiously, if necessary, and not exceeding a pre-set limit. “Higher doses are less safe for patients and there’s no evidence they provide extra benefit over moderate doses,” says Chou. In addition, he says that long-acting medications are more dangerous than short-acting versions when starting opioid therapy, but there’s no good evidence that they relieve pain more effectively.
  • Be realistic. The pain-relieving effect of opioids diminishes over time. In the long run, the drugs will only reduce your pain by about 20 to 30 percent—or they may not help at all. Work with your doctor to set realistic treatment goals and make a plan for what to do if they aren’t met. Your healthcare provider should evaluate your progress using standard assessments of pain and function within one month of when you start taking an opioid or increase the dose and at least every three months as long as you take the medication.
  • Expect to be monitored. Doctors are advised to screen your urine for opioids or other drugs before starting you on a prescription painkiller and at least annually thereafter to make sure you are taking the medications as prescribed. “Don’t take it personally,” says Chou. “People from all walks of life become addicted to opioids; the only fair and reliable way to find out who’s having trouble with the drugs is to screen everyone.”

Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Source of study:

Here’s hoping this information reaches you in as good of health as possible.  These are only guidelines for doctors to go by.  I look forward to any comments and will try any answer any questions or do what I can to find an answer.

Thank you,

Richard Kreis

iCare Consulting

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