Wikipedia: Quackery is the promotion of fraudulent or ignorant medical practices. A quack is a “fraudulent or ignorant pretender to medical skill” or “a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan”.
Mark Sullivan, MD, PhD, outlines steps for opioid tapering
We really need to look at whether patients consider their lives improved as a result of opioid treatment. My University of Washington colleague Jane Ballantyne, MD, and I recently published a commentary in the New England Journal of Medicine…
Many patients struggle with insomnia and anxiety as they taper opioids. It’s important that prescribers don’t add medications such as sedatives, benzodiazepines, or muscle relaxants that can increase risk of opioid overdose in unpredictable ways. Tricyclic antidepressants, like nortriptyline, can provide a safer alternative treatment for anxiety and insomnia.
Since antidepressants only work for (maybe) up to 30% of patients (and that’s for treatment of depression, not chronic pain, where the percentage is significantly lower), what other “safer” treatments do you suggest for anxiety and insomnia? And how do you treat symptoms like anxiety and insomnia that have arisen from the chronic pain itself? Oh, that’s right, doctors are refusing to treat pain, so now they can only “treat” the comorbid conditions — when they’re actually treating the pain with antidepressants…
Perhaps most “experts” don’t know this, but the use of antidepressants to treat chronic pain is actually off-label, except for a very few, specific, chronic pain conditions. Off-label use of medications (not approved by the FDA) has been under a lot of scrutiny lately and the results don’t look good (at least for the patients). So, what does it say about an “expert” who is advocating for off-label use of prescription medications? (Has the FDA approved the use of antidepressants for anxiety and insomnia?)
I have found that many patients in the subgroup taking high doses of opioids have untreated or undertreated psychiatric disorders, such as depression or post-traumatic stress disorder, which need to be monitored carefully. Opioids can mask symptoms of these disorders, so that when a patient comes off opioids these symptoms may reappear or worsen.
Opioids “mask” these symptoms, just like they “mask” pain? And when these drugs are taken away, the symptoms reappear or get worse? Dude, are you trying to say that opioids are actually treating PTSD and depression? And because of the opioid war, doctors have to take away these successful treatments? Replacing them with… antidepressants?
As I predicted, the only drugs doctors are going to prescribe for pain (anxiety, depression, PTSD, etc.) are antidepressants. Broke your leg? Here, have some Effexor. Dental pain? Here, have some Paxil.
My blood pressure increases every time I read one of these articles, but the scary part is that this quackery is becoming mainstream.