Doctors Call For Pullback On Narcotics For Chronic Pain

I am prepared to take some flak for what I’m going to say.  It’s simply my truth.
I’ve avoided taking pain medication because I was intimately privy to the experiences of my clients who have been on pain medication. I’ve never met anyone with a painful chronic condition, with the exception of terminal cancer patients, where I believe pain meds made their life better.  Initially their pain was more tolerable but their life was not better.  In the worst cases, it was a downhill spiral, needing more and more medication, higher and higher doses which led to less and less functioning.
 
I’m not against pain medication or meds in general. I do think narcotics are appropriate for intractable pain.  Thank goodness my own Mother and Father were on morphine at the end of their life (my Mother for years with spinal nerve pain).
 
 The people I see whose internists have put them on pain meds without exploring alternatives and watching them get worse and worse as they up their dosage are the ones I am speaking about.
 
Medications are a gift to be used when appropriate.  Ultimately  it is only the person who suffers who can make that decision.  The difficulty is that when pain levels are so high there’s desperation for any relief.  Initially narcotics provide that.  I’m not convinced it’s needed for many who have been on them with little or no relief.

Doctors Call For Pullback On Narcotics For Chronic Pain
by SCOTT HENSLEY

http://www.npr.org/blogs/health/2011/09/16/140540259/doctors-call-for-pullback-on-narcotics-for-chronic-pain

“Painkillers like these being counted at the Oklahoma Hospital Discount Pharmacy in Edmond, Okla., need to be used far less often, some prominent doctors say.
In a bracing call to action, three doctors from California are telling their peers to think twice before prescribing potent narcotics for patients with chronic pain.

Drugs such as Vicodin, Percocet and Oxycontin have become among the most prescribed in the country. Between 15 and 20 percent of patient visits with physicians the U.S. include a prescription for an opioid, the modern painkilling medicines whose roots can be traced back to the opium poppy.

But their editorial, published this week in the Archives of Internal Medicine, says there’s a troubling shortfall in the evidence to support the use of such drugs for long-term treatment of pain. And, there’s ample evidence of harm.

“Unfortunately, the use of prescription opioids currently results in more deaths in the United States due to intoxication than heroin and cocaine combined,” says Dr. Mitchell H. Katz, a co-author of editorial, in a podcast. “That’s shocking.”

Doctors’ prescriptions for the medicines that are supposed to decrease pain and improve patients’ ability to function, he says, are “killing more people than two drugs that we think of as lethal, so much so that they’re illegal.” The death toll from the legal pain pills is about 12,000 a year, he says. “It’s a public health problem.”

So what’s their prescription? Until there’s more scientific evidence, doctors “should not continue to prescribe high-dose opioids” for chronic non-cancer pain. Narcotic drugs for short-term relief of pain are fine, but Katz says there’s insufficient evidence to support their use over the long haul.

Instead, doctors should talk with patients about the limits of pain relief and give alternatives to opioid drugs such as physical therapy or yoga, their due. To some patients, doctors may need to give a sobering message, Katz says in the podcast: “This is not something I’m going to be able to completely take away.”

The bottom line of the editorial, part of a series in the journal called “Less Is More,” a rethink on these narcotics that is overdue.

What do the pain specialists think? I asked for a comment on the editorial, and got a statement from Dr. Robert Chou, who heads the group at the American Pain Society working on guidelines for clinical practice.

“While it’s important for clinicians to be more thoughtful about who they prescribe long-term opioids to and to stop opioids when they aren’t helping or there is evidence that it is causing problems, the American Pain Society believes opioids have a role in the management of chronic non-cancer pain in carefully selected and monitored patients.

There is evidence from long-term observational studies and evidence coming from some long-term clinical trials that opioids are effective for improving pain in some patients.

For example, we do not believe that a trial of low doses of opioids should be denied to a low-risk woman in her 70’s who has severe hip arthritis, who may be able to garden and walk with decreased pain on it.

While the data on overdose deaths and abuse of opioids should concern all members of society, it does not justify an  extreme blanket position of no opioids for chronic non-cancer pain.””

Lost in pain or drugged?

Questioning where my life went

Don’t know which is worst

35 comments on “Doctors Call For Pullback On Narcotics For Chronic Pain

  1. Very interesting debate. I have seen some excellent results for chronic pain relief with very low doses of Amitriptyline (which is a type of medicine called a tricyclic antidepressant (TCA). This type of medicine acts on nerve cells in the brain.)

    It is particularly good for pain such as neuralgia and back pain and the doses are much less than needed for the antidepressant usage. It is a useful ‘background’ therapy, which can then be supplemented with analgesics if they are needed. .

    Like

    • Sarah (I’m assuming that is your given name? – as you remain anonymous on your blog)
      I also assume you are a medical doctor or in the medical profession as you seem very knowledgable about medications.

      I took Elavil many years ago but had no relief. Currently the non-narcotic “drugs of choice” in the US are Cymbalta, Neurotin and Lyrica. (They have been heavily promoted on TV).

      My experience is that pain management in the United States is not well understood or researched by many doctors. They tend to throw patients whatever the latest Pharma Rep has given them samples for or hand out Rx for potent drugs too easily.

      I VERY much appreciate your comment which adds another dimension to the subject and helps everyone keep open to possibilities they might otherwise not known about.

      Like

  2. I am one of those who has a prescription for narcotic pain relievers…Vicodin.

    I try not to take it except when the pain is at it’s worst. My doctors are amazed how long my prescription last. I’ve often had to ask for a new prescription because I didn’t use the refills in time. But, I’m glad I have them on hand. When I have a migraine that nothing else will touch, my pain pills are a blessing.

    I used to take NSAIDS for my chronic hip and pelvic pain, but developed horrible stomach troubles because of them. (I can’t even take Advil now).

    I do take Limbrel, every day, it is a pharmaceutical food supplement that helps with inflammation. It has been wonderful, and it’s not a drug. I do have to have a prescription for it, but it has helped my hip and pelvic pain more than anything else I’ve tried.

    I try other methods first. meditation, deep breathing, bio-feedback, massage therapy, but when nothing works…I’m grateful I have Vicodin.

    I admit I’ve been taking more than I’d like since I had my last spinal fluid treatment on Aug. 22nd. But still I’m not taking any where near the amount it says for me to take. (no more than 2 per day…and often I don’t take any) I’m also on a lower dose, and sometimes I cut them in half.

    I believe with proper management, and supervision narcotics can be a successful part of pain management. But, it should never be the only thing used to control someone’s pain.

    (I’ve seen people get to the point where they need more and more…and feel they need it even when they don’t…I think it’s appalling when a doctor will prescribe a narcotic before trying other methods of pain control. I also think it’s horrible when a doctor does not supervise their patients better when they are on such drugs). I don’t think it should be so easy to get pain killers. I’ve gone to 3 different doctors for different types of pain (migraines, hip, and pelvic), and each of these doctors offered to give me a prescription for a narcotic. I always give my doctors a list of the meds I’m on, so this shouldn’t happen with me. There needs to be a better way to monitor this type of thing.

    just my two cents.
    wendy

    Like

    • Wendy
      That was worth 2 billion cents. It sounds like you are using pain meds extremely responsibly. I respect you and honor you. And thank you so much for telling your story so that others may benefit. That’s my highest hope for his blog.
      Love,
      judy

      Like

  3. i think it’s a tough call here, it depends on the situation. when my loved one was on her last stages of her cancer illness, the only thing that can relief her pain is the morphine that the doctors gave her. i can’t bear to see her in such pain, and if a narcotic drug can give her some hours of relief, so be it.

    you have written an interesting and thought-provoking article here. thanks for sharing!

    Like

    • Dsnake 1,
      Absolutely, I agree it does depend on the situation. For me End of life palliative care is an absolute must. Morphine is appropriate and you were right – she did not need to be in that pain. Both my parents had morphine (my father was in Hospice care) at the end of their lives.

      I am so sorry for your loss. It is such a helpless feeling to see someone you love in that kind of pain.

      Like

  4. Painkillers progressed more to that of the pain. A Higher level of pain begets a higher dosage – a battle at odds eventually!.Good observation!

    Hank

    Like

    • Hank,
      Pain is our bodies way of telling us something is wrong. We do try to KILL things off that we don’t like. . . pain only being one of them. They have their place and are appropriate for many people but unfortunately it has become big business.

      Like

  5. Very interesting read!! Over dependence on chemicals (medicines) is slow deterioration and erosion of the insides, so I think it is wise not to become a slave to these drugs unless it is absolutely necessary!! I have seen drug companies peddling their wares by offering attractive incentives, which later becomes habit forming!!

    I am one for alternative medicines. Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic, naturopathy, and homeopathy.

    The various alternative treatment methods are effective in treating a wide range of major and minor medical conditions,because they offer a non-drug approach to treating some health conditions.This is my firm belief entirely through my own experiences.

    Finally a Haiku for healthy living 😉

    Answer is in youth
    Keep alive that youthfulness
    Way beyond your age

    Life is short to waste
    Brain activity does help
    Opines viv and me

    Excellent food for thought Judith!! 🙂

    Like

    • Nanka,
      Thank you SO much for adding valuable information to my post. I love it when people take the time to comment and add depth and breath to the topics.
      Your list of Complementary medicine treatments is excellent. The only thing you left out is THERAPEUTIC CREATIVE EXPRESSION – journaling, painting, sewing, doodling, drawing etc.!

      Your Healthy Living Haiku is PERFECT!

      Keep your eyes posted
      for a “haiku comments” post
      with my appreciation

      Like

  6. Pingback: What to do about pain in a dog?

  7. Judy, I agree with you. I can’t tell you how many clients I know have made their lives worse with pain meds. I had a time when I was in terrible pain – couldn’t even hold a deck of cards in my hands. I don’t take pain meds unless I’m desperate because they upset my stomach. I was lucky, it was a pituitary tumor causing it and when I had it removed most of the pain went away. Now I manage my body and join pain (arthritus) alternatively and I do mostly WELL. Love Laurie M.

    Like

    • Laurie M,
      I so glad you commented. I think it’s helpful for others to read the comments to gain even more perspectives than just mine. We are all in this world together and the more we can communicate the better.
      xxxxxx J.

      Like

  8. Overmedicated society? Watch TV for more than hour on almost any network and you’ll see multiple ads for pharmaceuticals. Neurolgists prescribed ever-increasing doses of steroids and then Indomethacin for a diagnosed “cough headache” I’ve had for almost 2 years. Finally getting actual relief after working with some great Osteopaths. D.O. treatment was summarily dismissed as “unproven” by one Neurologist, and a “waste of your time and money” by another when I asked about it as an option (since I was getting no relief from ‘modern’ medicine) and requested a referral. Less, or even none, is sometimes WAY more.

    Like

    • Rick,
      The ads on pharmaceuticals are mind-numbing. ( Maybe that’s a cheaper and more effective way to go — just watch med commercials.)

      Steroids are a close second to narcotics. I’m so glad you are beginning to get some relief.
      xxxx J.

      Like

    • Viv,
      I think distraction is excellent. It does work for awhile. That’s one of the reasons I love creative expression. There are studies that show when involve in something creative, blood pressure lowers and immune function rises.

      Like

  9. There are several challenges to managing chronic pain with options. As the body sensitive to the med, the patient needs higher dosage for it to work. Addiction ia another problem. You can also experience rebound pain; making the condition worse. Unfortunately, both patients and doctors are resistant to trying alternatives. The book Full Catastrophe Living examines the use of mindfulness meditation in pain reduction. The program was used in a pain clinic. It helped. The book also teaches mindfulness skills.

    Like

  10. Lorraine,
    thank you for your thoughtful reply. I’ve added some copy to clarify my position.

    I absolutely support pain medication for the kind of pain you experience. I have a client with similiar facial nerve pain. The only thing that gives her any relief is Marijuana.
    I myself tried Lyrica. Unfortunately, it didn’t do anything.

    Let me know if my post is a bit clearer now in terms of my beliefs.

    Like

    • sorry — i’ve been off line for a variety of reasons, including trying not to add to my facial pain.
      I hope I didn’t misunderstand or misstate. I think alternatives to narcotics are great and I wish that I either could afford, had access to, or could take alternatives to meds of any kind. Unfortunately, my health care provider would rather pay for a monthly script for low dose morphine than acpuncture, massage, or physical therapy at the place of MY and MY DR. choising. There is something inherently wrong with that. I wonder if other people are faced with the same problem and if that feeds into the over medication (in general) and opiates/narcotics in particular? Having already paid/enrolled in a health care plan, their options for treatment are limited by the health care provider?

      Like

      • Lorraine,
        No you didn’t misstate at all. And yes, what you described is very widespread here in California. Alternative medicine is almost never covered by insurance – there are a few exceptions. Ironically the one thing that has coverage is costly inpatient treatment for alcohol/drug addiction. Mental health care is usually limited to 20 sessions a year and then the insurance discounts fees paid to providers by 75% to 50% of fee. I work per hour for less than a massage, manicure/pedicure/ hair coloring or dinner at a medium priced restaurant for 2! But I digress over my personal “pique”!

        Like

  11. I would agree about the use of narcotic drugs…I have always believed less is more. I have Fibromyalgia and I was once given Ultram to attempt to manage the pain. I had never taken the drug as prescribed. I always took less, but once while in a severe flair I used it as prescribed and had a seizure. I applaud the strength and questions in your haiku. Something we should all ask ourselves.

    Like

    • Susie,
      Yes, If we thought about it pain meds do not have a GPS (not yet anyway) to go only to the site needed and there are often horrible side-effects if they aren’t the right drug for you. One day they will be able to take a blood sample or scan our bodies to know exactly what is needed. But until then it’s a crap-shoot and the doctors admit it.

      A seizure is scary scary scary.

      Like

  12. oops, when the comment gets too long, the box starts to jump. It should read “will I consider” not condier. I’m never pain-free despite the Lyrica, naxproxen, and flexeril. I can’t remember what pain-free felt like (I had a lot of pain as a kid, too).

    Like

  13. It’s a tough one; I can’t take or use many of the natural/homepathic pain rememdies due to allergies. I take Lyrica for facial nerve pain; it, too, is now considered a controlled substance” although it isn’t an opiod. (Folks say it makes them happy; no wonder, the nerve pain has been reduced). I realize that I’m lucky; I can tolerate Lyrica, and unlike other meds, I’ve been able to stay at the same dosage for several years. I could have another temporary nerve block (if I paid for it myself — around $20,000), or a permanent one that could lead to facial paralysis (it’s where two nerves cross in my neck that causes the pain in my face). Lyrica doesn’t work on the other pains for osteoarthritis, osteoporosis, IBS, and now computer usage and my neck; for that, I relay mostly on nonopiate pain relievers. I guess it comes down to, I think everyone should have the choice. I watched my mother go through agony for 7 weeks before her dr. called in the palliative care guy who “drugged her up.” I would gladdly have signed off on giving her whatever pain meds she needed to be comfortable. My pain is such that I’m never comfortable; Lyrica cuts down on the nerve pain, but now my neck has gotten much worse making computer usage an extremely painful experience. Will I condier going back on opiates for my neck? If I want to continue to participate in the cyberverse, it’s a tough call I’ve got to make.

    Like

Click on "LIKE" to let us know you visited. Comments HERE!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.