Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions.

Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions. Anesth Analg. 2017 Nov;125(5):1769-1778 Authors: Ballantyne JC Abstract An overreliance on opioids has impacted all types of pain management, making it undoubtedly a root cause of the "epidemic" of prescription opioid abuse in the United States. Yet, an examination of the statistics that led the US Centers for Disease Control and Prevention to declare that prescription opioid abuse had reached epidemic levels shows that the abuse occurrences and deaths are arising outside the hospital or hospice setting, which strongly implicates the outpatient use of opioids to treat chronic pain. Such abuse and related deaths are occurring in chronic pain patients themselves and also through diversion. Overprescribing to outpatients has afforded distressed and vulnerable individuals access to these highly addictive drugs. The focus of this article is on what we have learned since opioid treatment of chronic pain was first popularized at the end of the 20th century and how this new information can guide chronic pain management in the future. PMID: 29049121 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Every physician takes the Hippocratic oath and promises to “do no harm.” In the face of the current opioid epidemic, this includes protecting our patients from dependence and addiction, including those who are suffering from debilitating acute and chronic pain. Sometimes this involves getting creative as we develop treatment plans. Luckily, opioids are not the only, nor always the best, defense against pain. One patient who avoided the negative side effects of long-term opioid use was Beth Hunt. Beth was living life...
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This study questions the effectiveness of standard therapies (SQ insulin, IV fluids) in lowering blood glucose in type II DM patients who present to the ED with hyperglycemia but are otherwise well-appearing. Across 566 such encounters there was only an association with modest blood sugar reductions while significantly increasing the ED length of stay (in regards to IV fluid administration). Prior work from this group (https://www.ncbi.nlm.nih.gov/pubmed/27353284) questioned the value of lowering the blood sugar at all in well-appearing hyperglycemic type II diabetics. Add this to a lack of significant reduction and it may...
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Abstract As the United States experiences an epidemic of prescription drug abuse, and guidelines on safe practices in prescribing opioids in chronic pain have subsequently emerged from professional organizations and governmental agencies, limited guidance exists for prescribers of opioids to treat pain in patients with cancer or terminal illness. Patients with active cancer or terminal illness often have pain and are frequently prescribed opioids and other controlled substances. Current studies suggest that patients with cancer have similar rates of risk for misuse, abuse, and addiction as the general public. More...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
On September 8, 1854, acting on the advice of Dr. John Snow, London municipal authorities removed the pump handle from the Broad Street well in an effort to halt a major outbreak of cholera. Although an anesthesiologist by profession, Snow had methodically mapped the homes of new cases of cholera. He found that many clustered around the Broad Street pump. Snow’s findings, still regarded as a classic example of epidemiology, established the principle: “that the most important information to have about any communicable disease is its mode of communication.” Dr. Snow did not establish the biologic mechanism ...
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On May 25, the Interagency Pain Research Coordinating Committee (IPRCC) and the Office of Pain Policy of the National Institutes of Health (NIH) released draft Federal Pain Research Priorities, which were presented and discussed at a forum and public comment period on June 1. The forum immediately followed the Annual NIH Pain Consortium Symposium, where presentations highlighted multidisciplinary strategies for the management of pain. Following the open public comment period, written comments will be accepted until June 6.The Federal Pain Research Strategy (FPRS) is an effort to oversee development...
Source: Psychology of Pain - Category: Anesthesiology Source Type: blogs
The opioid epidemic knows no boundaries. The epidemic is not limited to race, profession or socioeconomic status. Since 1999, the number of overdose deaths involving opioids (heroin and prescribed opioids) nearly quadrupled with more people dying from drug overdoses in 2014 than recorded in any prior year. The Centers for Disease Control and Prevention (CDC) reports that 78 Americans die every day from an opioid overdose. At least half of all opioid overdose deaths involve a prescription opioid. Despite recent initiatives that have been put into place to curb the number of opioid related deaths, such as public availabilit...
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BRIDGEPORT, W.Va. — The doctors wanted to talk about illness, but the patients — often miners, waitresses, tree cutters and others whose jobs were punishingly physical — wanted to talk only about how much they hurt. They kept pleading for opioids like Vicodin and Percocet, the potent drugs that can help chronic pain, but have fueled an epidemic of addiction and deadly overdoses. "We needed to talk about congestive heart failure or diabetes or out-of-control hypertension," said Dr. Sarah Chouinard, the chief medical officer at Community Care of West Virginia, which runs primary care clinics acro...
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In an effort to curb America's deadly opioid crisis, federal health officials are urging doctors to largely avoid prescribing highly addictive painkillers like OxyContin and Vicodin when treating patients for chronic pain. The new guidelines, issued Tuesday by the Centers for Disease Control and Prevention, are directed at primary care providers, who issue about half of all opioid prescriptions.  Since 1999, such prescriptions and sales have quadrupled in the United States, a boom that the CDC said has "helped create and fuel" the current epidemic of opioid abuse and overdose. In 2012 alone, d...
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As I have written before as a physician who saw too many dire results of intravenous drug abuse, I was amazed how narcotics were pushed as the treatment of choice for chronic pain in the 1990s, with the result that the US was once again engulfed in an epidemic of narcotic abuse and its effects.  In mid-December, 2015, as reported in the Washington Post,The nation continues to suffer through a widespread epidemic to prescription opioids and their illegal cousin, heroin. The CDC estimated that 20 percent of patients who complain about acute or chronic pain that is not from cancer are prescribed opioids. Health-care prov...
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Whenever I read or write about the overuse of so-called opioid painkillers it is with mixed feelings. As a lifelong back-pain patient who once depended on them for pain relief, I appreciate the challenge posed by opioids to people in pain and their doctors. People in agonizing pain want it to stop, but opioids are often a poor long-term solution. Doctors want to help their patients, so they may prescribe opioids for extended periods despite well-founded reservations. At the same time, the epidemic of abuse of these painkillers has led to numerous deaths. Like many Americans, I know people whose lives were destroyed—w...
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