Tuesday, 9 February 2016

Opioids Were Never Intended To Improve Function; Just Relieve Pain

Today's post from clinicalpainadvisor.com (see link below) is an ever-so-subtle addition to the current media-inspired movement that claims all things 'opioid' are bad. It addresses opioids and neuropathic pain directly and comes to negative conclusions based on the study results that show that opioids produce little improvement in function in people who take them. However, opioids don't address the disease and are not meant to be 'cures'. Don't these people realise that opioids are never meant to improve function - they're meant to reduce pain and in that respect, they are very successful. Of course, reduced pain can enable people to function better but only because their pain is gone, not because the original illness has been addressed. Of course the media realise this full well! Inventing negative effects that were never claimed to be benefits of opioid use in the first place, is a sort of negative publicity that's used in politics all the time. The fact is that if you are taking opioids for neuropathic pain, you have tried everything else and nothing works, leaving you with opioids that generally do the job. Of course they have to be controlled and monitored and the patient has to take some responsibility to make sure that the potential for addiction is minimised but good doctors should be monitoring you to within an inch of your life to make sure you're not entering any sort of spiral. Opioids have been used for pain control since the dawn of time but like everything in this modern world, we always seem to need a sledgehammer to crack a nut!

How Effective Are Opioids in Neuropathic Pain? 
Steve Duffy January 26, 2016

Improved function may not necessarily follow opioid treatment.

A new study suggests that opioid prescriptions for patients with neuropathic pain, may not improve their physical function or disability. In fact, results from the study — conducted by the University of Alberta and published in Pain Medicine — indicate that opioid use could be harmful when it comes to physical recovery for patients with neuropathic pain.

"We studied patients with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves, and the ones who weren't prescribed any opioids had statistically lower disability and higher physical functioning scores," said Geoff Bostick, PhD, lead author of the study.

TRENDING ON CPA: ACA Supports Proposed Guideline for Prescribing Opioids to Patients With Chronic Pain

The study sample included 789 patients with neuropathic pain across Canada. Patients gave self-reported measures of physical function (pain disability index) and a medical outcomes study short form-12 physical function (PCSS-12), at the beginning of the study, then again at 6 months and 12 months after treatment began. Analysis of covariance models was created to examine the association between opioid therapy and both physical functioning outcomes with adjustment for confounding.

Results showed that patients prescribed opioid treatment did not report greater physical functioning or lower disability than patients who were not prescribed opioids — even after the results were adjusted for disease severity. The improvements in disability and physical functioning scores from baseline and 12 months for all groups were "modest and may not be clinically significant," authors reported.

They asserted that while opioids are a powerful painkiller, the results of the study testify that improved function does not necessarily follow opioid treatment.

In addition, they highlighted the association between opioid prescription and a patient's quality of life, considering that the treatment may not be aiding the patient's functionality. They call for further research to analyze this correlation.

For those who have chronic pain but are medically cleared for physical activity, a graded approach to recovery is suggested, according to Dr. Bostick. "I tell patients to walk until they are at 50% of their tolerance — walk and stop before the pain gets too bad. Each week, walking time is gradually increased. Over time, this tolerance will slowly increase and so will physical function."

Bostick G, Toth C, Carr E et al. Physical Functioning and Opioid use in Patients with Neuropathic Pain. Pain Med. 2015;16(7):1361-1368. doi:10.1111/pme.12702.
This article originally appeared on MPR.


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