Do Opioids Carry More Risks Than Benefits In Chronic Pain?

Today's post from sciencedaily.com (see link below) looks at a new statement regarding opioids from the American Academy of neurology. It states that the risks posed by opioid prescription use, outweigh the benefits for people living with chronic pain. However, their conclusions are based on the overal numbers of deaths and recorded addictions, which must include the use of opioids for recreational use, even if they are 'prescribed' by doctors. This may give a false impression. The study says that 50% of people on opioids are  still on opioids 5 years later, which is hardly surprising if they're prescribed for chronic pain. Chronic pain does not go away and opioids are not designed to cure it. They relieve symptoms to improve quality of life. If the pain is so severe that the last resort of opioids is prescribed, then they will continue to be necessary for some considerable time. The article does go on to suggest a list of controls that doctors should carry out on long-term opioid users and these are completely relevant  but otherwise, this study seems to reinforce current prejudices, especially in the USA, rather than acknowledge the true benefits to the quality of life of people in long-term chronic pain. It's an argument that will run for ever!

Risks of opioids outweigh benefits for headache, low back pain, other conditions  American Academy of Neurology (AAN) September 29, 2014

Summary:

The risk of death, overdose, addiction or serious side effects with prescription opioids outweigh the benefits in chronic, non-cancer conditions such as headache, fibromyalgia and chronic low back pain, according to a new expert guideline.

According to a new position statement from the American Academy of Neurology (AAN), the risk of death, overdose, addiction or serious side effects with prescription opioids outweigh the benefits in chronic, non-cancer conditions such as headache, fibromyalgia and chronic low back pain. The position paper is published in the September 30, 2014, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Opioids, or narcotics, are pain medications including morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone or a combination of the drugs with acetaminophen.

"More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use," said Gary M. Franklin, MD, MPH, research professor in the Department of Environmental & Occupational Health Sciences in the University of Washington School of Public Health in Seattle and a Fellow with the AAN. "There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions and patients need to work together to stop this epidemic."

Studies have shown that 50 percent of patients taking opioids for at least three months are still on opioids five years later. A review of the available studies showed that while opioids may provide significant short-term pain relief, there is no substantial evidence for maintaining pain relief or improved function over long periods of time without serious risk of overdose, dependence or addiction.

The AAN recommends that doctors consult with a pain management specialist if dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day, especially if pain and function have not substantially improved in their patients. The statement also provides the following suggestions for doctors to prescribe opioids more safely and effectively:

• Create an opioid treatment agreement

• Screen for current or past drug abuse

• Screen for depression

• Use random urine drug screenings

• Do not prescribe medications such as sedative-hypnotics or benzodiazepines with opioids

• Assess pain and function for tolerance and effectiveness

• Track daily morphine equivalent dose using an online dosing calculator

• Seek help if the morphine-equivalent dose reaches 80 to 120 milligrams and pain and function have not substantially improved

• Use the state Prescription Drug Monitoring Program to monitor all prescription drugs the patient may be taking

"More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs," said Franklin.

Story Source:

The above story is based on materials provided by American Academy of Neurology (AAN). Note: Materials may be edited for content and length.

Journal Reference:
G. M. Franklin. Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology, 2014; 83 (14): 1277 DOI: 10.1212/WNL.0000000000000839

http://www.sciencedaily.com/releases/2014/09/140929174408.htm