Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

http://www.mayoclinicproceedings.org/article/S0025-6196%2815%2900303-1/fulltext

Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients’ psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers…

Gee, are those the only reasons discontinuing opioid therapy is problematic?  Could it be that doctors have nothing to replace it with?

Doctors to pain patients:  We’re going to taper you off this medication that helps you function every day and reduces your pain, but we’re not going to replace it with anything.  In other words, just suffer.  After all, suffering is better than the possibility of addiction or diversion, don’t you think?  Sure, unmanaged pain will shorten your life span, make you miserable, and may produce suicidal ideation, but so what.  We’re doctors and we know what’s best.

And the reason there’s “limited evidence” for long-term opioid therapy is because the research hasn’t been done yet.  Hey, I have an idea:  Why not do the freaking research?

You know what else hasn’t been proven to work on a long-term basis?  Antidepressants.  Go ahead, doctors, start tapering those medications too.  Pretty soon, we won’t even need doctors any more.

10 thoughts on “Tapering Long-term Opioid Therapy in Chronic Noncancer Pain”

  1. Ludicrous. It’s time they learned the difference between addiction and the ongoing need to diminish physical pain. There’s a huge difference between needing opiods/opiates to relieve physical pain, and using them to get high. Why don’t they understand that? And what about even when they do have alternatives, but some of us can’t take them without throwing up? The only family of painkillers I can tolerate are opiods/opiates, whichever the more natural of the two is, I forget which way round it goes. X

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  3. I assume that the people writing these “peer-reviewed papers” have never suffered from noncancer chronic pain. If they had they would never suggest that anyone suffering in that way should be made to suffer more.
    Without my meds I would be curled up in a ball on the floor every day. If that’s preferrable to me being able to move my body so I can do basic daily tasks, even if my mind is clouded, then there’s a huge problem looming in the medical community: stupidity blanketed in a lack of compassion for patients.

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      • I was very hurt and disappointed when I learned that my family doctor asked my therapist if she thought my pain was psychological. I haven’t felt like I can trust her since learning she asked that.
        I know that there are people out there that are legitimate drug-seekers and addicts, but to treat everyone who says they are in pain that way is crazy. Shouldn’t the default be “my patient has pain so I’m going to treat it” until the situation proves otherwise? This model puts so many people at risk of developing severe chronic pain conditions that can’t ever be treated

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        • I can understand doctors needing to ask every possible question regarding a patient. And of course pain has a psychological component — our brains are not divided between the physical and the mental. It’s all connected. But I understand how you feel about your family doctor asking that question — it’s a matter of trust. The question implies that your family doctor doesn’t believe you, so how can you trust her in the future? I can’t believe your therapist revealed that information to you, although if it was me, I’d want to know.

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        • Thanks for understanding.
          I have a very strong and long-time relationship with my therapist, whereas my family doctor is newer in my life.
          My therapist-psychiatrist team was concerned about the question because they had no doubts that my pain was real so to have my family doctor question it made them wonder if I was getting the support I needed. To me that relationship of trust is important because they have been involved in making sure I get access to resources I wouldn’t otherwise have, things that my family should actually have done.

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