F*ck, here we go again…


1/12/2015, Scant Evidence for Opioids in Chronic Pain

There’s no evidence for the long-term safety and efficacy of opioids in chronic pain — a fact long touted by advocates who have called for tighter controls on opioids, now supported by a large-scale evidence review commissioned by federal agencies.

Another government-sponsored report supporting the failed drug war…  I’m bored already…

Most randomized, controlled trials of opioids for chronic pain were shorter than 6 weeks, and nearly all ran for no longer than 16 weeks, according to Roger Chou, MD, of Oregon Health and Science University, and colleagues.

So, on the one hand, you’re saying that there is no evidence because the research hasn’t been done; and on the other hand, you’re saying this proves there is no evidence (of long-term safety and efficacy with opioid treatment).  You know, this kind of circular logic is the same kind used with medical cannabis…

And there is evidence of harm, including increased risks of overdose and abuse, Chou and colleagues wrote in their report — which was commissioned by the Department of Health and Human Services.

Of course there is evidence of harm — all drugs show harm with use, including many that aren’t even on the drug scheduling list.  And treating pain is what drugs are used for most, so of course you will see more harm in this patient population.

The real question is, do the benefits outweigh the harms?  My conclusion?  Yes, more patients achieve benefit than harm.  I’m talking about both chronic pain patients and those addicted to drugs.

Part of the problem is a lack of drug education — just like there’s a lack of sex education in this country.

The report was presented in September at an NIH Pathways to Prevention workshop evaluating the role of opioids in chronic pain. The workshop was co-sponsored by the NIH Office of Disease Prevention, the National Institute of Neurological Disorders and Stroke, the National Institute on Drug Abuse, and the NIH Pain Consortium — many of which are involved in drafting a National Pain Strategy.

This is so depressing…  All these government agencies working on making the lives of chronic pain patients even worse than they are now…

“The lack of scientific evidence on effectiveness and harms of long-term opioid therapy for chronic pain is clear and is in striking contrast to its widespread use for this condition and the large increase in prescription opioid-related overdoses,” Chou and colleagues wrote.

The lack of scientific evidence… because the research with the right controls hasn’t been done… it’s not there so it doesn’t exist.  Now I’m not only bored, but dizzy.

The panelists drew heavily from the report, concluding in their paper that opioids may work for some patients, but there are “probably more effective approaches for many others.”

Oh my god, I am so glad that someone has found “more effective approaches” for the treatment of pain…

So, weren’t you going to mention what these treatment options consist of? Maybe, because as a doctor, you feel funny recommending massage and accupuncture to treat chronic pain?  And what happens when all your customers switch from seeing a doctor to seeing a massage therapist?

Panelist David Steffens, MD, MHS, of the University of Connecticut, and colleagues wrote in their report that a rising tide of both chronic pain and opioid overuse has “created a situation in which large numbers of Americans are receiving suboptimal care.”

Please, someone define “suboptimal care”… Is that like being treated as a criminal and drug addict?  Or not being treated at all?

The root of the problem is a lack of knowledge about the best approaches to treating various types of pain and a dysfunctional healthcare delivery system that “promotes prescription of the easiest rather than the best approach to addressing pain,” they wrote.

Really?  Is that the root of the problem?  Well, okay, if you say so.  However, with the internet, you can’t really say there’s a lack of knowledge — more like the medical industry can’t figure out how to treat constant pain.

And we could give a shout out to the insurance industry, which refuses to cover all available treatment options.  In fact, you could put a lot of the blame for the overuse of drugs on the insurance industry — drugs are covered more than any other kind of treatment.  You know, because they’re cheap.  Or, at least, they used to be.

They issued several recommendations, including a call for studies to identify which types of pain patients are most likely to benefit — as well as incur harm from — opioids, the development and evaluation of multidisciplinary pain interventions and risk assessment tools, and that clinicians in the interim should follow the recommendations of their professional societies when it comes to prescribing pain treatments.

Blah, blah, blah…

MedPage Today and the Milwaukee Journal Sentinel have launched several investigations into the lack of evidence for the use of opioids in chronic, noncancer pain. The stories revealed that behind that surge in opioid prescribing was a network of pain organizations, doctors, and researchers who pushed for expanded use of the drugs while taking millions of dollars from the companies that produced them.

And who’s behind the surge in the drug war, and the criminalization of pain patients and those addicted to drugs?

Yes, pain patients can easily conclude that MedPage Today is obviously run by some government agency — does it matter which one?

Richard Deyo, MD, MPH, of Oregon Health and Science University, and a co-author of the HHS review, expressed doubt that the type of randomized trial evidence now needed regarding opioid therapy would ever be done.

So, there’s no evidence, and none will be forthcoming.  Huh.

Another controversy in the opioid space has been a Institute of Medicine report that estimated 100 million Americans live in chronic pain, particularly because experts who drafted the report had close ties to opioid drugmakers.

And MedPage has ties to (and is likely funded by) the Government.  And the Government is addicted to the drug war.  Now, which is worse?  The greedy corporations or the anti-science government?

But Steffens and colleagues noted in their workshop report that while 100 million patients may have chronic pain, it’s a much smaller number that has moderate-to-severe chronic pain that limits activity and diminishes quality of life: about 25 million.

I dunno, 25 million people suffering from constant pain sound like an awful lot of people to me…

Are government connections and funding not considered conflicts of interest?  Sure, to the government.

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