Wednesday, February 24, 2010

New Studies on Chronic Pain Drug Prescriptions - TIME

In a review published in the Jan. 20 issue of the Cochrane Database of Systematic Reviews, a leading evidence-based-medicine journal, researchers found that only one-third of 1% of chronic-pain patients without a history of substance problems became addicted to opioids during treatment. The review included 4,893 mostly middle-aged chronic-pain patients, who were treated with opioids for between six months and four years. "This suggests that people who do not have a history of drug abuse or addiction are not highly like to develop [addiction] under physician care," says Meredith Noble, lead author of the review and senior research analyst at the ECRI Institute, a health care research and consulting group near Philadelphia.

In some cases, however, undertreated pain may contribute to a situation that looks like addiction; patients ask for higher and higher doses and appear to be drug-seeking, when in fact they are looking for effective pain relief.
 
Citing the many risks of long-term NSAID use, including fatal ulcers and gastrointestinal bleeding, increased risk of heart attack and stroke and dangerous interactions with other drugs commonly prescribed to the elderly, the American Geriatrics Society suggested that seniors try acetaminophen instead. If that doesn't ease pain, older patients are advised to use opioids like codeine or morphine, which don't have the same risks.
"We're not saying opioids are innocuous. They are dangerous drugs," says Dr. Bruce Ferrell, who chaired the panel that authored the guidelines. "We are saying that there is a substantial proportion of the population for which opioids might be a better choice than NSAIDs."
While in some cases, doctors are using these powerful drugs too often, in others, concerns about misuse may have caused pain patients to suffer unnecessarily. "There is both overprescribing and underprescribing," says Volkow, who notes that, for instance, many dentists give opioids like Percoset too freely to teenagers after surgical procedures; in contrast, "you have individuals with very severe pain who are not given opioids or who are given doses that are [too low to treat the pain], and that in and of itself can put them at risk."

Read more: http://www.time.com/time/health/article/0,8599,1964782-3,00.html#ixzz0gUI5EURL
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NSAIDs give me ulcers, yet even after starting to develop one, I was still refused prescription pain relief.
 
Dr. Teicheira says "if severe pain is allowed to persist for more than 24 hours, neuroplastic changes associated with the development of intractable chronic pain syndromes are evident -- damaged mechano-receptor nerve grows over the nociceptor nerve after 24-48 hours; the nociceptor atrophies."  In other words, your fibromyalgia may be iatrogenic: caused by doctors who refuse to prescribe pain medication until you have tried to "tough it out" for a few weeks.
 
My health has improved greatly since I finally -- after 7 years of requests -- got a prescription pain reliever that allowed me to sleep through the night and function during the day.
 

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