There is no, that is no evidence that long term opioid management provides relief, improved function, improved quality of life or return to work for patients suffering chronic pain. This in spite of 20 years of “pushing” these dangerous medications by the pharmaceutical companies who seem to have attempted to get every person (with pain) in America addicted.
An excellent article by Erikson in the 2006 edition of Pain reviews 10,000 patients in Denmark and concludes that NONE of the goals of opioid use for chronic pain are being met, and calls for further research.
There has been none as far as can tell which would pit non-opioid treatment, (NSAID, exercise, PT, amitriptyline, gabapentin or even acetaminophen) to opioid for say, longer than 6 months.
We have walked more or less blindly into being led to think that “opioids are safer than NSAIDs”, that “there is no ceiling effect” that “we undertreat pain in America” which are all ridiculous statements promulgated by the Pharma industry to get doctors to quit thinking these drugs are addicting or dangerous.
It’s the story of Valium all over again. Nobody uses diazepam to attempt to treat chronic anxiety any more - it’s now clearly understood that long term treatment with diazepam makes anxiety worse. So it is with opioid, hyperalgesia with chronic “exposure” to opioids has been demonstrated first in rats, subsequently in humans. This means that pain may become worse over time with opioid use.
I have been board certified in the area of pain medicine since 1994 and I am watching the pendulum slowly swing back to the idea that these drugs are dangerous and should be used with caution, and close monitoring. It is refreshing to see the Medical board increase its vigilance in order to reduce the death rate, and even more significant, the morbidity associated with the medications.
By Allan Zacher, MD on Aug 10, 2013 at 5:19pm
