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Study: Opioids vs Non-Opioids for Chronic Pain


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I found this surprising.  Disclaimer, my mom has severe arthritis and has been on opioids for years.  She is in her 80s.  I am not in favor of trying to get people like that off whatever is working for them.  But studies like this could be interesting for initial prescribing.  Also, if non-opioids are NOT working, people should still get what they need to help the pain.

 

https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true

 

 

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There was a comment on this study that I totally agree with:

 

Pain conditions are very debilitating for thousands of people. It’s sad that many pain patients are being treated as “drug addicts†and are cut off from their prescriptions without being offered other treatment options. One of the issues is that medical care is not individualized based on each patient’s needs and history. Providers should use a comprehensive physical and psychological assessment to determine the best course of treatment for each patient. We can’t keep using the same standard methods for every patient. In fact, that's partially what got us into this mess in the first place. We know the research has found that opioids are not an effective long-term pain treatment for many and the risks of addiction and overdose often outweigh the benefits. However, this isn’t the case for every patient and human care is not cut and dry. When discussing the treatment options for chronic pain, opioid dependence and mental health conditions, providers must consider each patient’s history, goals and quality of life. Let’s individualize treatment and help patients who are in desperate need.

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There was a comment on this study that I totally agree with:

 

Pain conditions are very debilitating for thousands of people. It’s sad that many pain patients are being treated as “drug addicts†and are cut off from their prescriptions without being offered other treatment options. One of the issues is that medical care is not individualized based on each patient’s needs and history. Providers should use a comprehensive physical and psychological assessment to determine the best course of treatment for each patient. We can’t keep using the same standard methods for every patient. In fact, that's partially what got us into this mess in the first place. We know the research has found that opioids are not an effective long-term pain treatment for many and the risks of addiction and overdose often outweigh the benefits. However, this isn’t the case for every patient and human care is not cut and dry. When discussing the treatment options for chronic pain, opioid dependence and mental health conditions, providers must consider each patient’s history, goals and quality of life. Let’s individualize treatment and help patients who are in desperate need.

 

So true!!!  

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There was a comment on this study that I totally agree with:

 

Pain conditions are very debilitating for thousands of people. It’s sad that many pain patients are being treated as “drug addicts†and are cut off from their prescriptions without being offered other treatment options. One of the issues is that medical care is not individualized based on each patient’s needs and history. Providers should use a comprehensive physical and psychological assessment to determine the best course of treatment for each patient. We can’t keep using the same standard methods for every patient. In fact, that's partially what got us into this mess in the first place. We know the research has found that opioids are not an effective long-term pain treatment for many and the risks of addiction and overdose often outweigh the benefits. However, this isn’t the case for every patient and human care is not cut and dry. When discussing the treatment options for chronic pain, opioid dependence and mental health conditions, providers must consider each patient’s history, goals and quality of life. Let’s individualize treatment and help patients who are in desperate need.

 

:iagree:  :iagree:  :iagree:

 

 

My mom is also in her 80's with terrible arthritis and has been on a low dose of an opioid for years. Pain medication makes her able to live independently. Acupuncture has been helpful for her, after I convinced her to try it (that took a while!) 

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That is why although I am glad to see studies being done, and would like to see even more studies with alternative pain treatments, I don't like that they will likely be used to try to deny people treatment.  We can never seem to find a middle ground.  :glare:

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There are a large number of elderly people and non elderly people with chronic pain who can't take any NSAIDS because of being on Coumadin or other blood thinners. So if Tylenol doesn't do it, they are out of options besides opioids.

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There are a large number of elderly people and non elderly people with chronic pain who can't take any NSAIDS because of being on Coumadin or other blood thinners. So if Tylenol doesn't do it, they are out of options besides opioids.

 

NSAIDS can also do a number on your stomach and aren't recommended for people with any kind of stomach issues or acid reflux disease. Acetaminophen can destroy your liver.

 

I don't think researchers/the medical community take chronic pain - that can't be fixed with surgery - seriously. There needs to be more done to find or create a pain reliever that works without either being addictive or destroying some other part of your system. 

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Most people do not have addiction problems.  Most people do fine on opioids.  As two people here said, I can't take aspirin, ibuprofen, etc, because of two reasons- one, I am on a blood thinner that forbids it and 2) before I even was on the blood thinner, I developed esophageal spasms from using NSAIDS.  Those felt like heart attacks and the treatment was nitroglycerin and no  more NSAIDS.  For me, low dose opioids due work to lessen pain.  Not only does acetaminophen increase my chances of liver problems, it also does zilch for my pain.  

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There are a large number of elderly people and non elderly people with chronic pain who can't take any NSAIDS because of being on Coumadin or other blood thinners. So if Tylenol doesn't do it, they are out of options besides opioids.

 

Absolutely, my Mom can't take ibuprofen which has always worked for her because of her heart meds.  Tylenol is useless.

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We are talking with the psychiatrist (also works at a pain clinic) about LDN for chronic pain for my 19yo. My 19yo can't take Advil or Aleve and Tylenol does absolutely nothing. My 19yo has not had a moment without pain for the past 4 years and it will never go away. There is no treatment or cure for Ehlers Danlos. 

 

I'm hoping that maybe LDN can help.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

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We are talking with the psychiatrist (also works at a pain clinic) about LDN for chronic pain for my 19yo. My 19yo can't take Advil or Aleve and Tylenol does absolutely nothing. My 19yo has not had a moment without pain for the past 4 years and it will never go away. There is no treatment or cure for Ehlers Danlos.

 

I'm hoping that maybe LDN can help.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

I have a very close friend that has EDS.

((Hugs))

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My grandmother took opioids regularly for maybe the last 5-7 years of her life after a bout with shingles.  I don't know whether she had chronic pain or was just addicted or both; there was no effort made to suggest alternatives to her.

 

It made her unable to live alone and also unable to do a lot of the things she'd done before - she couldn't drive herself much of anywhere so she lost touch with a lot of her normal community, etc.

 

When she did die, of oral cancer, they didn't have a lot to offer her in the way of pain management.

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I have a very close friend that has EDS.

((Hugs))

We’ve recently found out that I have EDS as do two of my sisters. I have had to have multiple surgeries over the years for ruptured tendons and other issues, and now we know why. Fortunately I don’t have chronic pain anywhere but my ankle, but I took opioids for years simply due to the number of surgeries I was having to repair things.

I pray they find something soon.

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The doctor has prescribed LDN. We have a great compounding pharmacy and they are going to provide it for us. 

 

Hopefully this will help. According to what I've read it seems like it can take some up to 5 weeks to see an effect from it if they do have any effect from it. Others get nothing from it at all.

 

The interesting thing is that it is recommended to take between 10pm and 2am because of when your body produces the most endorphins. LDN can triple the number of endorphins your body produces.

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