Opioid taper – please comment. Your story matters


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Opioids

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Americans use 80% of prescription opioids in the world.

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If you have voluntarily tapered off opioids, please comment

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In 1991, America was not even among the top 10% prescribing opioids for cancer pain. Now look where opioid induced pain has led the way medicine is practiced. We have created disability like throwing gasoline on fire. It is costing lives.

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Patients with intractable pain who have failed all  procedures, nerve blocks, injections and opioids, why are they still taking them if pain is still severe, if they are not able to function? They do worse than nothing.

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Opioids create pain: They trigger the brain to produce pro-inflammatory cytokines that cause pain. It is drowning in a universe of delusion to ignore the data. Clinging to fear.

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Data: Here’s an old Stanford study from 2005 Journal of Pain:

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Opioid Tolerance and Hyperalgesia in Chronic Pain Patients After One Month of Oral Morphine Therapy: A Preliminary Prospective Study

 

Abstract

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There is accumulating evidence that opioid therapy might not only be associated with the development of tolerance but also with an increased sensitivity to pain, a condition referred to as opioid-induced hyperalgesia (OIH). However, there are no prospective studies documenting the development of opioid tolerance or OIH in patients with chronic pain. This preliminary study in 6 patients with chronic low back pain prospectively evaluated the development of tolerance and OIH. Patients were assessed before and 1 month after initiating oral morphine therapy. The cold pressor test and experimental heat pain were used to measure pain sensitivity before and during a target-controlled infusion with the short-acting μ opioid agonist remifentanil. In the cold pressor test, all patients became hyperalgesic as well as tolerant after 1 month of oral morphine therapy. In a model of heat pain, patients exhibited no hyperalgesia, although tolerance could not be evaluated. These results provide the first prospective evidence for the development of analgesic tolerance and OIH by using experimental pain in patients with chronic back pain [my emphasis]. This study also validated methodology for prospectively studying these phenomena in larger populations of pain patients.

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Perspective

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Experimental evidence suggests that opioid tolerance and opioid-induced hyperalgesia might limit the clinical utility of opioids in controlling chronic pain. This study validates a pharmacologic approach to study these phenomena prospectively in chronic pain patients and suggests that both conditions do occur within 1 month of initiating opioid therapy.

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Of course when you stop the opioid, the system rebounds like wild, stronger pain. It’s one thing to publish this important study, but how to offer better relief than the adjuvants that failed?

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How has opioid’s overwhelming inflammatory imbalance in brain affected the ability to recover? ever. The brain is maxed out. Is it permanent? How long does this last? There are those who think, I won’t taper off, I’ll wait till the very last minute, do rapid detox and expect instant change. Do not allow brain recovery. Opioids are still in system for weeks after stopped.

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People more likely to remain on disability if opioids are even once started. Doctors then prescribe tramadol, Nucynta, buprenorphine in patches or film for sublingual use. Those are still opioids.

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And one week ago, two more opioids approved. They make billions, guaranteed lifelong. Why should pharma try something that will actually relieve pain without causing inflammation centrally in brain?

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The problem is that patients who taper off have been offered nothing adequate to replace the opioid.

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The question is, if FDA refuses to approve any more opioids, will pharma do anything to relieve pain?

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The material on this site is for informational purposes only, and is not a substitute for medical advice,

diagnosis or treatment provided by a qualified health care provider.

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Please understand that it is not legal for me to give medical advice without a consultation.

If you wish an appointment, please telephone my office.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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