Tuesday, 31 May 2016

Do You Take Opioid Strength Medications For Your Neuropathy?

Today's post from nationalpainreport.com/ (see link below) is another very sensible article looking at the problem of what to do with patients who take their strong medications to control their pain sensibly but are now confronted by pharmacists, insurers, media and politicians who have decided in their wisdom that these people can simply do without! Yes, it's a North American problem at the moment but don't be fooled, it will spread across the world because of the international nature of the health industry.  This article asks the very pertinent question: who's thinking about these patients and what are they going to do about them? Are they going to be left to suffer pain unnecessarily because of an inflated hype? Well worth a read.

Reduce Opioids – Then What?  
Posted on May 24, 2016 in Pain Medication  By Ed Coghlan

When we read that opioid prescriptions are not only being reduced, but also Cigna, a major health plan, was committing to reduce opioid prescriptions by another 25% in the next three years, it again brought up a question that has been asked but seldom answered by government regulators (or insurers like Cigna).

“If opioids are going to be reduced, then why aren’t we talking about the alternatives to them for patients who use them responsibly?”

We turned to Beth Darnall, PhD from Stanford University. Beth is Clinical Associate Professor in the Division of Pain Medicine at Stanford University and author of Less Pain, Fewer Pills. She writes about using less medication—but also talks about alternatives.

She thinks we have to do more than simply reduce opioid prescriptions:

This is a great question. First, we need individualized pain care- one size does not fit all. Broadly speaking we need 3 things:

(1) Alternatives.
It’s shortsighted to simply take something away: we have to give alternatives, ideally make them available before medications get started.

(2) Understanding that the patient experience is critical.
Simply taking away opioids can engender anxiety, anger, and feelings of injustice—especially in those who believe the medications are working well. In all of the conversation about whether opioids are good or bad, there is not enough focus on how to ease the emotional distress of patients on this issue. We need to acknowledge the emotional distress and deliver treatment approaches to reduce it. Give them access to alternatives. Then, if opioids must be tapered, help patients feel more in control of the process. Tapering works best when anxiety and stress are low. I write a lot on the under appreciated importance of this topic.

(3) Recognize that most patients take opioids responsibly.
The issues of whether opioids are good for chronic pain (on average) and addiction have been conflated. In my experience, the vast majority of patients taking opioids take them responsibly and exactly as prescribed. They are doing nothing wrong! Whether or not they work well, improve function, and have low side effects and low risks is a separate issue, and this is where most patients find that opioids are no panacea. The problems they experience have nothing to do with addiction or so-called “aberrant behaviors”. Patients are doing everything right, taking medications as prescribed, and they are having problems caused by the medications. In these cases – and I have seen many—tapering opioids helps reduce problems. They get better. They still have chronic pain, but they had it before on the opioids, too. Granted, when I work with patients I help connect them to those alternatives so that the focus is on managing pain differently with key lifestyle changes and use of skills. They may begin other non-opioid pain medications that may have lower risk profiles.

There’s no perfect solution here because each patient is different. Opioids do work well for some people with chronic pain, and even with the CDC guidelines in place prescribers have discretion to prescribe the medications long term. Ideally, there will be less of a focus on treating pain with opioids ONLY, as has been the case in the past.

The second question that bothered us in the wake of Cigna’s announcement was the fact that many insurers simply don’t cover alternatives.

Now, we have a new problem: insurance companies do not provide good access to the opioid alternatives so desperately needed by patients. How about providing free chronic pain self-management classes to patients? Free or low cost pain psychology classes? We need scalable solutions to meet the treatment needs of millions of Americans. In an ideal world the U.S. would have put these solutions in place before issuing edicts on prescription limits.

Here’s last week’s story on Cigna’s decision to reduce opioid prescriptions.


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