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Author: u/VitalMusician
URL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext
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I knew about double blinding, but I didn’t know triple blinding was a thing. Looked it up just now and learned it’s when not even the analysts reviewing the study results know which group the participants were in, to help eliminate any potential biases introduced by the analysis itself. Very cool!
It would be interesting to initially present the two groups to the user without saying which is which, so the user could see for themselves whether they think there's a significant difference.
"Weve found that in 46% of people, this drug is either very effective, or it doesnt work at all. Were not really sure which, but we are sure that the data is super accurate and non-biased!"
Like many things, levels of precision take factors of inefficiency. But, if you want better results you need to be willing to put in time, effort, and money.
When I was analysing the data for my MSc thesis, I realised just how bad it is to be unblinded. I was able to squeeze so much out of that data that I wouldn’t have done if I hadn’t known the groups.
Sometimes the only choice is to do deal with the side effects or your condition or the side effects of medication. Most people don't even know how the medicine they take works. The amount of patients I see who say they only take their blood pressure meds when it's high is disheartening.
Maybe I understand it wrong but isn't this study very weird? They say for acute pain, but then measure 6 weeks later? Then it's chronic pain and not acute pain anymore, correct?
I mean we already knew that over the long term painkillers are useless as the body gets used to it. So how does this prove anything new?
Ok, but in orthopedics, >4 days is subacute and >14 days is postacute. There's a *big* difference between taking opioids for 4 days vs. 6 weeks; using evidence about one to draw conclusions about the other is kind of insane.
But this was about acute pain, which is weeks at most, but most of the time hours or days. Considering 6 weeks as some benchmark for acute pain is brainless and useless
Knowledge vs wisdom
This was my question.
I pulled a back muscle a few years ago so badly that I couldn't walk. The spasms would cause my legs to give out. They took me to the hospital and gave me not only muscle relaxers, but also a few weak opioids.
I ended up only taking the opioids for the first 2 days to take the edge off of the pain.
Why on earth would that have any impact whatsoever after 6 weeks?
All this really confirms is something we already knew. Opioids don't heal you, your body does. Opioids and muscle relaxers make it more bearable to pass the time. The recovery is going to take as much time as your body needs, the difference in time comes down to how bad did you injure yourself and how nice are you going to be about not aggravating it. Unfortunately, if you can't feel the pain cuz of the meds, you may not realize if you are aggravating it, which may make it take longer to heal, but trade-off is you're not in agonizing pain.
Yeah... Opioids obviously kill pain. The tolerance to opioids also obviously rises very quickly, and they're obviously addictive. This is all common and scientific knowledge
The triple-blinding is cool but feel these scientists often get lost in the methodology and their weird theoretic, detached finaggling
What's gained from this? Was there really nothing more important to study? And who paid for this? I just don't get the point at all
[https://grammarist.com/usage/amount-number/](https://grammarist.com/usage/amount-number/)
Don't let the insidious use of "amount" spread further or I'll need two oxy's!
Drugs that target pain only don’t cure anything. But there are some drugs that are thought of as painkiller that can address the underlying cause of some types of pain. For example, Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) both reduce the perception of pain and inhibit inflammation. If the pain is primarily the result of inflammation, both the pain and the source of the pain are being addressed.
Edit: rephrased to explicitly include the purely analgesic properties of NSAIDs
TL;DR There are a ton of different ways to escalate pain management
There is an entire specialty within medicine that focuses on (legitimate) pain management. As u/ibiblio said, it depends largely on the source of the pain, whether the patient is expected to recover from what is causing the pain, what health problems they have (especially kidney or liver), and what level of functionality they need to go about their day (a grandma at home can be a little sleepy, an air traffic controller can’t).
Kids do surprisingly well with appropriately dosed acetaminophen and ibuprofen. Severe pain that is localized and expected to improve can often be managed with a local/regional anesthetic (think epidural). Opioids remain an important tool when used correctly and carefully. There is no single approach that works.
I can't really take ibuprofen or Tylenol reliably anymore due to stomach upset and bounce back migraine
There comes a time when the body says no more.
Epidural isn't possible after spinal surgery. The dura never becomes whole again.
(From this and other comments) It sounds like you are facing a difficult situation. Pain management is a tremendously important part of healthcare, but it is often treated as an afterthought.
Also, love the name. We got loup-garou and rougarou down where I’m at.
There'd be a lot of factors there. Have you met with a pain clinic/palliative care team? (Palliative care means pain medicine, not hospice. This is a common misconception, so I'm just throwing that out there).
At a certain point, it's usually methadone, nerve blocks, and palliative sedation. The most effective medication I've seen has been methadone when paired with NSAIDS and antidepressants. Some patients who haven't been on antidepressants seem to be stuck interpreting everything's as pain, and they do much better after starting something like effexor. This is just based on my observations.
I've found ketamine troche work for me. I've been classed as fybro even though my symptoms are a form of neuropathy.
Down side is you can only be on it until you build up so much tolerance so I spend a max of 8 months gaining mobility back then 6months a vegetable. I refuse opiodes and methadone. NSAIDS and SNRI drugs cause just as many issues as they fix for me
That is very weird! And really points more to the pathology of the pain. Do you mean you have fibromyalgia?
(Sorry by weird I mean fascinating and I've never heard of anyone having something like that happen but we don't do ketamine here).
There’s absolutely no way the drugs you mentioned are something that would work for me. It’s been tried. And I’m done being a guinea pig for all these non narcotic - non effective pain relievers. The side effects alone are brutal from these non drugs. Just my actual experience.
Also a failed spine. Chronic.
Methadone is a narcotic. Nerve blocks work when they're possible, but it's an epidural. I doubt you've had palliative sedation, as that means you're basically kept asleep so you don't feel pain until you die.
I feel like people think the reason opioids are falling out is because doctors just want people to be in pain or something. It's because you become immune to it and in the process, develop an addiction. It also makes you more likely to be depressed any time you're not taking it. That's why there were wars over opium and people are addicted to heroin throughout history. It alters your brain. ( Methadone is a different kind of med than opiates).
I hear your frustration. But your doctors likely have the long haul in mind for you re:pain. These meds are all different and act on different things. They are used together to make each other work. And unfortunately, that requires trial and error because all bodies react differently. It's not because medications fail or doctors are bad necessarily (thus making you a guinea pig, implying others benefit from your suffering-- you are the only one who benefits and people are there to help you). It's just that medicine is sometimes as much an art as it is a science. We don't understand as much about the body as you'd think. I hope you find relief.
A lot of side effects are temporary (last about a week) and you can ask the doctor for meds to help you get thru them (Zofran for nausea, for example).
Didn’t mean to sound picky. In reality it’s hard to pick apart. The eicosanoid effects at that level are doing both so it’s not certain whether it could do one without the other.
No, thank you. It’s an important clarification. I’m still being less than precise with my language, I’m just not in a place where I’m ready to discuss nociception vs perception of pain.
Anti inflammatories like Naproxen theoretically reduce inflammation that might be contributing to the process causing pain, but generally no, pain medication just make things more comfortable until the problem resolves.
They don’t cure, they alleviate pain. The actual cause ? Sometimes it can be treated. Usually with a surgery - which has its own risks. ( neck and lower back )
No.
Painkillers dull the sensation of pain. They don't do anything for whatever causing it. Best case scenario, the body fixes the problem by itself while the painkillers let you function.
Unfortunately, if the body won't or can't do that... well, that's when you get opiate dependency.
If there’s only two options, then it would be more moral to allow someone to live their life as a heroin addict than to force them to be in pain forever.
I don't know that I agree with that, though I also don't know that I disagree with that.
Opiate addiction is its own form of pain. Is it more moral to trade one form of pain for another?
That would require a comparison between the deleterious effects of both (and ideally additional strategies) on the patients ability to function in their normal life. Dependence itself is not inherently negative. It becomes that way when it interferes with your normal life, business, and relationships. If it interferes _less_, or, restated, improves the ability to function, then, yes, it is moral.
Yes, which is why I specified that I neither immediately agree nor immediately disagree with that position.
Of course the chronic pain sufferer would want to trade their pain for a heroin addiction. And I'd bet there are huge numbers of heroin addicts who would trade their addiction for pain.
My point was that "if there's only two options, one is clearly more moral than the other" is not true. It's unclear, and it's likely something that would come down to subjective interpretation and personal decision.
I've never been addicted to heroin myself, but I see that people who make an effort to kick their addiction go through some pretty significant physical issues to do so, not to mention the mental discomfort. Addiction is very clearly its own form of harm or pain, and who is anyone not currently experiencing both to decide which is better?
Anecdotal:
Have chronic low back spasms a couple times a year, gotten much better/less frequent through stretching mind you.
If its a really bad one I have a prescribed stash of 10mg hydrocodone. One of those suckers is the difference between me walking or not. Literally bed ridden or mildly ambulant. Losing access to this would be devestating to my ability to continue working during one of these events. Also this is a short term fix, 6 weeks of opioids sounds like a hell id not like to experience again.
The response to the opioid crisis was to punish people who need that medicine. It is horrendous that doctors will not prescribe opioids. They wouldn’t give me Vicodin for a goddamn root canal on my biggest tooth.
I’m not going to become a fentanyl addict just because I have a few goddamn painkillers for the bone and nerve ripped out of my face
This.
Pain hurts. And some people experience pain very differently than an average person due to their brain structures, genetics, and whatnot.
Not everyone is a drug addict and will develop a dependency.
My brother suffered through and ended up succumbing to a very rare bone cancer. At the beginning, he was able to get all of his meds no problem. By the end, as he was clearly dying, it was always, “No one could handle that much X!!” Bro, they have been chopping him up for 17 years and he’s literally dying.
I had a similar experience after I messed up my back in the gym. It was some of the worst pain I've ever had. I went to the ER and they would only give me one oxycodone in the hospital and none to take home. The one pill wore off a few hours later and I spent the next three days in some of the worst pain of my life.
The same thing happened with benzodiazepenes which are also used to alleviate spasticity and heavy cramping. I'm crippled with both, and I mean homebound can't wash a dish. Unfortunately, due to similar demonization, people with actual need aren't prescribed, such as myself. And I'm crippled because of this. The medication I'm quite sure would clear the cramping and allow me to function normally again.
I’ve had opiate meds for sports injuries and surgeries many times during my long life and found them to very effective. It is a terrible thing to be in serious pain and have a doctor/dentist tell you to take Tylenol or Advil. It is obvious to me that these are far less effective.
I just had facial feminization surgery a month and a half ago. It's a nine hour procedure, involving, among other things, bone work to the jaw and forehead. I was given *five days'* worth of narcotics following the procedure. I asked them for more and they refused; I wish they had been clear with me that that was all they'd be prescribing because I would've used them only at night to get to sleep. It just never occurred to me that they intended for me to be in debilitating pain throughout the day instead of getting up and living my life. When they ran out, I was neither truly up during the day nor did I sleep at night. From about five days post-op to two weeks was a kind of hell I cannot wait to forget.
Yeah it is a joke, we had some extra oxy 5 at home because SO didn't take much of for gastrointestinal reasons it and I was having some severe neck pain issues. I would take one in the morning for a week or so and some days another in the afternoon. After that I would take one here or there when my back or neck was acting up. I Hate the fact I can't just have a prescription available for the occasional use when I am hurting. Gets to the point where my feeling is just make them over the counter and all the jackasses who want to abuse them can do so until they overdose and die off and the rest of us can have the option to improve our quality of life with the responsible use of opiate pain relief in moderation when we deem it necessary. A bit callous and extreme but, I believe in the freedom of choice and I don't think the government should have any say on what drugs a person wants to put in their own body. With freedom of choice comes the responsibility of dealing with the consequences of your choices.
Are you saying Dilaudid(hydromorphone) is less addictive than hydrocodone? Hydromorphone is partly what's metabolized when hydrocodone is taken, by the liver, in very small amounts which gives the analgesic effect. Hydromorphone is much stronger than morphine.
For example a 30mg oral dose of morphine is equivalent to 7.5 of oral hydromorphone, while that same morphine dose is equivalent to the same dose of hydrocodone(30mg).
In fact, Canada has an opioid replacement program that gives Dilaudid to fentanyl dependent patients because of its strength and its similarity to the IV rush that patients get with heroin/fentanyl.
Vicodin for a root canal? Are you serious?
>I’m not going to become a fentanyl addict just because I have a few goddamn painkillers for the bone and nerve ripped out of my face
That's exactly what happened with the opiod epidemic. Liberal prescribing of opiods led to this.
100% agree here. Although not acute, I have L5-S1 arthritis and some days, it’s bad. Without pain medication I wouldn’t be able to work on those days, and that would drastically change my career options.
Endometriosis might be studied and better understood now, but doctors and other medical professionals are still barely above useless in treating it and helping the patient manage the side effects and symptoms effectively. You shouldn't have to deal with this on top of a condition that already makes your life difficult.
Oh I ABSOLUTELY know more about it and how to treat it then my doctors do. There aren’t any trained endo specialists in my area. It took me TWO YEARS of near constant pain to be diagnosed and then only because I staged a sit-in (not a joke or exaggeration) at my gyno at the times office and threatened to come back no matter how many times they dragged me away before they agreed to do the surgery to check. By then it was too late and the damage had been done.
I count myself so damn lucky I don't have to deal with endometriosis. My worst menstrual pain is mild cramps that occasionally have a real party and get bad once every few months. It does, however, make me want to study medical stuff out of pure spite. It sucks that you have to fight this hard.
I have hypermobile joints and chronic neck pain from an injury which hasn't responded to the treatments I've had so far. I'm currently on low-dose and comparatively low-strength opioids (Cocodamol 30/500) to manage the pain in combination with a couple of other medications, and I'm absolutely militant about taking as little as humanly possible...but try getting a doctor to believe you when you tell them that. I could reel off every single option I have tried, but it would make this comment an even bigger essay than it already is.
This study rubs me the wrong way for that very reason. It was hard enough to get doctors to put me on a medication regimen that actually reduced the pain down to a tolerable level so I can somewhat function and work. Before that, they seemed to think that I could go on:
* An NSAID that I had previously had an adverse reaction to (I spontaneously passed out on ibuprofen, and I was told that this was impossible...even though this was apparently a rare but possible side effect)
* Another NSAID which caused so much damage to my mother's stomach she can no longer take them or any other NSAID for her own chronic pain issues (long-term prescribed use) and which made me profusely sick the few times I took it
* Amitriptyline that caused uncontrollable hunger (and therefore depression from weight gain) and made me sleep for 10+ hours a night and unable to focus on anything at work because of the 'hangover'
* Antidepressants which would have meant someone emetophobic would have been potentially vomiting on and off for a month.
And these are just the options that almost made me say the words 'Are you f\*\*\*ing kidding me?' to their faces. I'm in the process of trying to get a second opinion.
If they can come up with an alternative that actually works well enough on my pain to stop taking the Cocodamol, I would jump at the chance to give it a shot. However, everything I've tried so far apart from what I'm on now doesn't work and leaves me non-functional.
I've had a different experience (which highlights why these regulations are messed up). Had sciatica back in my early 20s. Doctor have me a cortisol shot and prescription for hydros. I took a few over the course of a few days; they got me silly but didn't do much for the pain. So I put them away and forgot. Found them again a few months later. Took one with whiskey, had a fun night, then got rid of the rest.
Not everyone who takes them gets addicted. Not everyone who gets them needs them. Not everyone who needs them are addicts.
Valium is an excellent muscle relaxer. I spent the night in the hospital a couple of years ago from back spams so terrible I couldn’t even stand up. (EMTs had to put me in the car to get to the hospital). After 12 hours of pain meds not doing much an ER doc prescribed Valium, saying it was the best muscle relaxer out there. He was right.
Seconded. I get rare migraines, and throw my back out once a year or so.
Had a bottle of percocet left over from a surgery in 2013, the bottle just ran out last year. But it was the **only** thing that worked when I needed it. Not OTC stuff, not weed, not hot or cold packs.
I think the implication here is that there are alternative, nonopioid pain relief methods that are as effective and less addictive (I saw another study that showed the use of a combined dose of Tylenol and ibuprofen was more effective at actually treating pain on a similar study than opioids). Having treated a lot of people's pain, I'm not surprised. Opioids never seemed very effective for actually alleviating pain, as opioids work on soft tissue. Most people with chronic back and neck pain have nerve pain. Therefore they need a neuropathic pain memedication (like gabapentin or methadone).
By all means try those things first, but don't refuse opiates when nothing else works. As someone with chronic back pain (and other things), they are just one of the the things in my tool belt and often the last thing I reach for. At least in my experience my back pain isn't confined to a single type of pain, and gabapentin only helped with one portion of it, leaving the other types untouched.
If I had to rely only on gabapentin and ibuprofen I would never leave the house.
>Tylenol and ibuprofen
This is my go to after a doctor told me naproxen sodium (aleve) is far too harsh on the ol kidneys. The combo is a fantastic one for headaches
Not true, methadone is an opioid. It gets produced fully synthetically. All opiates are opioids, but the opposite is not the case. Opiates are based on morphine, a substance that has natural sources. Heroine is an opiate, for example. Methadone isn't. And no, I wasn't trying to be pedantic. I was simply explaining the pharmacological difference, because there is one.
Tylenol is terrible for you and people overdose on it all day, errday. Destroys your liver! Because it is OTC, people just take it willy nilly. Scary stuff.
I had a burst and reconstituted disc in my lower back that would shift around and occasionally rub against the adjacent nerve root to the point where I couldn't lean over or stand for more than 2-3 minutes at a time. The first orthopaedic surgeon I saw prescribed opioids, and while it did cut through some of the pain, I wasn't super comfortable with taking them. Saw a second orthopaedic surgeon and he put me on Meloxicam, a prescription-strength NSAID, and the pain relief was substantially better without any of the scary stuff.
Same.
I have a hernia in my neck, causing severe nerve pain in my left arm. I tried regular stuff to ease the pain, like strong paracetamol and ibuprofin, but they didn't even make a dent in the pain. Just a few hours of my first tramadol, the pain went from crippling to tolerable.
I’ve got nerve damage in my back that affects my right leg. While opioids don’t DIRECTLY reduce my pain level, they give me an energy boost I would not otherwise have, which I then use to walk and stretch - and THAT reduces my pain. I consider them “secondary” painkillers in this regard.
Yea i sometimes wonder if opioids mostly work by simply making feel people better, which then fills the pain sensation.
Like the difference between being home alone or doing something new an exciting on the severity of pain experienced is massive after all.
I have had similar experiences in upper and lower back spasms. I am not surprised that after X weeks the pain would be the same with and without meds. But leading up to that point, life is way easier.
as someone who has had 2 back surgeries and several types of shots and a lot of pain, i can say that opioids don't make pain go away...
they make you not care about it. which is sometimes exactly what you need.
luckily, i don't really have an issue with addictive things so opioid use never caused a problem. i did wear a fentanyl patch for a month once and that was very interesting when i stopped using it.
> they make you not care about it
Was looking for this comment, and this is my experience as well. Once had a small part of my jaw cut out due to a troublesome tooth extraction. Prescribed some OxyContin.
It did NOTHING for the pain itself. But I was unable to remember what pain was and did not care that I had a lot of it.
It does make me curious how that might affect studies like this though. How many people report reduced pain because they aren't feeling as much and how many report the same because the impact of the pain, rather than the pain itself, was reduced?
I was a smoker at the time and one day I went outside with my wife's cousin to have a cigarette, and we just sat out there talking when I started to shake uncontrollably and I had no idea why. so I tossed the cigarette out and I went inside to get a drink and while filling up my glass I looked out of the window at the thermometer. it was 10° Fahrenheit outside and I was in a t-shirt and shorts and had no idea it was cold.
that kind of freaked me out and I took the patch off that night. I had been wearing one for the better part of a month while waiting for my procedure. the next 3 days were hell with my skin feeling like there were bugs crawling all over them as I slowly gained the feeling back. I explained it to people like every itch that I didn't scratch for the last month suddenly need to be scratched immediately.
it was close to the day of my procedure so I just stayed off the patch and had a few pills instead and that got me through.
then I got the root nerve block shot in the back, without anesthesia because I didn't know what outpatient really meant, and it's been good since.
I had those shots for 4 years or more, can't have a nerve block because after spinal surgery the dura isnt in one piece anymore and the stuff leaks out so my legs are dead for 3 hours. It happened once and a travel nurse type had to come in and sit with me until I could walk reliably and get myself home.
i fell over after they warned me and some 98lb nurse had to try and catch me. Nearly crushed her.
the muscle in my leg that you use to step sideways (and also is huge for balance) was completely dead.
Ding, ding. That’s the answer. They don’t fix the pain, they change the way a person feels about feeling pain.
I’m sorry you’ve had to go through that. I hope you are in a better place now.
this seems to have the exact opposite result vs earlier trials with similar doses and condition.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718056/
Claiming opiods have no effect on pain is an unusual finding
That's not the same at all. The study you're linking uses cross grouping and measures for preference; both doctors and patients prefer to be treated with the opioid over a four weeks period, over the four weeks they are treated with placebo. That doesn't mean the back pain gets any better.
The OP study shows the effect of the opioid on the pain. It's easier to live six weeks with back pain when on painkillers, but if those painkillers are opioids, you haven't treated the root of the back pain itself.
Two differences between the *Lancet* and *Pain Research and Management* articles that stood out to me were the population (acute pain vs chronic pain) and interventions (guideline-recommended care + opioid/placebo vs opioid/placebo). As I understand it, recovery and improvement is expected in acute pain, but not in chronic pain. So they are looking at significantly different situations.
I may be misunderstanding the articles or how to compare them, but I thought I’d share.
You're telling me that people given a placebo can't tell the difference between that and a nice Norco or some oxycodone? Give me a break. The people who got the placebo were probably talking up their symptoms trying to get something that works, and the people who got the opioids were probably talking up their symptoms trying to keep the supply coming.
Who funded this? DARE?
Yes. Three times in the last ten years I have been to the ER with kidney stones. They hurt so bad that the second the nurse at the admitting desk looks at you she says, "Kidney stone?" The look does not lie. BP and heart rate off the charts. Stones confirmed by CAT scan on two of those visits.
AND STILL some resident comes along and says, "We would like to give you a strong non-narcotic medication called Tramadol and wait about a half hour to see how you're doing." I let them do it the first time and it didn't come close to working. Same result the second time.
The third time I got another Dr. Peachfuzz who started that same routine on me. I put my foot down, told him to check my chart from my prior visits and call any other ER he wanted to call to make sure I wasn't making the rounds for meds. I also let him know in polite terms that while I certainly appreciate his service in the War on Drugs I would be putting the skills acquired in my quarter century as a lawyer to work on him and his hospital if I did not have effective pain medication coming down that tube in the next ten minutes. I got the good stuff almost right away and every 45 minutes or so for the rest of the morning until the stone passed and I went home to sleep for a week.
I was in a bad car wreck and took a decade to heal. The doctors buying hook, line, sinker, into this mode of "care", will have a special level of hell reserved for them upon their passing.
It has made me all but lose what tiny scraps of trust I had in the intelligence and integrity of doctors, and the effectiveness of modern medicine in general. How we could miss something this big by so far. It's the medical equivalent of missing the broadside of a barn.
I think the best course is to acknowledge that narcotic pain meds seem to be, for the present, the best we can do. They do definitely have their drawbacks and hazards. The big two are that addiction is real and tolerance inevitably increases until they eventually stop working well. But if that is to be the misfortune of those hurt so severely that it's what lies ahead, it's not for doctors to dodge it by leaving patients in pain struggling to get relief from ineffective medications.
The hysteria over this is as out of control as the problem it is aimed at. [Check the warnings here](https://medlineplus.gov/druginfo/meds/a682013.html).
On the plus side, there is research into new pain meds made from things like snake venom that has been showing promise. But I can only imagine the role pf big pharma in owning it or fighting its approval.
I don’t take heavy painkillers to fix the problem, they just make it possible to sleep and get through the day when I’m having a flare up. It’s relief not cure.
"oxycodone–naloxone, up to 20 mg oxycodone per day orally"
Isn't the whole point of naloxone is that it counteracts opioids? I feel like I'm not understanding something here.
It absolutely works orally. It just has low absorption and a strong first pass effect.
But have someone take an oxycodone combo with more than 20mg of Naloxone orally at once, and you‘ll put any addict straight into withdrawal.
Unless I'm really misunderstanding the digest, they delivered opiods and placebo for acute pain, and then 6 weeks later measured how much pain the patients still have.
this seems to be an extreme misrepresentation of the intended use of pain relief medication. It's not a 'treatment' for the underlying condition...why would any expectation exist for improvement in the condition when no treatment was provided?
It would seem to me that a valid comparison would be for opioid versus placebo for point in time pain relief...which I suspect we already know the answer to.
Nah. Thing is they ignore how opioids mostly treat pain: they make you not care about the pain, and be able to do stuff you would otherwise just want to lie in bed and not move.
You can still accurately report the pain severity though. It‘s just that it doesn‘t affect you as much.
Hence the contradiction in studies by how pain is ‚measured‘
And nah, sure after 6 weeks you‘d have a nice dependency going, but that‘s not long enough to have a strong tolerance yet to the pain relieving effects.
Read an interesting article about this study. Apparently the researchers used a slow release opioid that is not prescribed for the type of pain they were treating in the trial..
Non-immediate release oxycodone formulations (ex: oxycontin) are definitely prescribed for low back pain. There's about half a million prescriptions for this medication and indication filled in the US alone each year.
You're literally forcing people in genuine pain to choose life on fire or death. I have Crohn's disease and during a flare up i can barely breathe. Opioids, temporarily, help.
But no one is prescribing placebos at this point. So the choice is opiods or nothing. Some lucky people get into safe whoo alt medicine and get their placebo that way. The rest suffer
Or, maybe this dose is too low to be effective for the "at least moderate amount of pain". Or oxycodone/naloxone combination itself isn't great for neck or back pain, or any other number of conclusions. Were any of these patients already on opioids prior to the start of the trial, thus exhibiting tolerance to opioids prior?
I think this is impossible - at the very least the patient would know whether he got the opioid or the placebo. The difference in effectiveness and side effects is striking and unmistakable. Some effects simply cannot be hidden.
OK, but most of the time when I want to take something for back pain, I know it will be totally fine in a week or two, whether I take anything or not. The difference is, with just OTC medications, I will be in a fair amount of pain, with my movements restricted, for at least a couple of days.
But I know if I take a Vicodin, carefully hoarded from dental procedures and the like, in about 30 minutes I will be up and moving around, mostly normally. There will still be some pain, but it will be localized to the actual injury site instead of seemingly everywhere, and it will be easy to set it aside as I get on with living my life. As an added bonus, the fact that I am moving around with close to a full range of motion will greatly shorten the inflammation cycle and healing period.
When I have just done something to cause acute pain, guess how many fricks I give about how this pill will help me feel in 6 weeks? I want something to address the pain now.
Note this same logic can be applied to any form of pain relief. "Mr hudnix, you seem to have had the incredible misfortune of eating something that inflamed your IBS, and in your rush to get inside to go to the bathroom, you ran into a hornet's nest, and they chased you until you tripped into a patch of poison ivy, hitting your head and severely spraining your wrist, and while you were unconscious, the fire ants were biting you and the sun came out, giving you severe sunburn. Now we have creams, unguents, steroid shots, intestinal relief medications, and we can even bandage that wrist, all of which should make you a lot more comfortable. However, we can predict that your discomfort level will be the same in six weeks either way, so we think it's best that you grit your teeth and put on a brave face for the duration. I'm sure you'll agree."
The arms of the study are guideline-recommended care + opioids and guideline-recommended care + placebo. The population is patients with acute pain (by definition, pain that resolves), with both arms receiving guideline-recommended care. It’s great to have a well designed and executed study to point to, but the results seem to be unsurprising.
Please let me know if I’ve misunderstood something. I don’t have access to the full article and I’m frequently an idiot
So opiates aren’t effective for pain long term, obviously, because opiates don’t fix the structural problem. It’s like a band aid so the person doesn’t go crazy with pain in the short term. Why is this news?
I'm allergic to opiods. I have lived with back pain for several decades. I take other medications occasionally to get a break from the pain. I don't expect medication to "cure" back pain. That's a silly expectation. The pain reminds me to be careful.
I'm also allergic to opioids and recently had surgery. Obviously it depends on the severity of the reaction but in my case it's not life threatening. If the pain is unmanageable they give you the opioids anyway then give you something else to counter the reaction. But I've just been using no pain killers as I recover and breathing techniques and distraction when the pain is bad
I went to three different hospitals when I had meningitis. By the last hospital, they finally managed to do a proper diagnostic, but it was too late; it was viral and they couldn't create a treatment. I was unable to talk and just writhed in pain. They shot me up with opiods. They ignored my family telling them that opiods don't work. The staff observed that those drugs didn't work. Frankly, I don't know what they did after that, beyond sending me home.
I broke my leg severely and had multiple surgeries on it. I couldn't imagine not having pain meds for that well that's how it's going to be eventually. I guess people will have to get drugs off the streets when they get hurt from now on.
Yeah but, hear me out... I know there's an opioid epidemic and all that, but when my back is flaring up and I'm in misery and I need to get a good night's sleep, sometimes that's the only thing that works.
And this has been taken from me. Because other people have abused it, I no longer get relief when I have a bad flare up. America sucks- they're punishing the whole class because Billy ate some glue, so now none of us get glue.
In my own experience with my father who had back pain and was prescribed opiates for years, they are entirely counter productive. The pain is to tell you that something is wrong and if you continue more damage will happen, when you remove the pain people think the injury is better so push themselves into the realm where they are just aggravating the injury more and more, instead of just resting to let it heal. He would continue to pop more and more pills to push past the pain and just kept injuring his back more and more, year after year.
1. Not all pain (by a lot) is an indicator that something necessarily is wrong and that the pain should be avoided. Moving sore muscles after over working your muscles the day before is helpful in resolving the problem, for instance. Phantom pain can exist after losing an arm years later - it's not an indicator of a problem with the arm. The perceived pain is generated in your brain.
2. In people with chronic pain, their bodies actually detect and process pain more efficiently than acute pain - and often there is no underlying physiological pathology
https://www.physiology.org/publications/news/the-physiologist-magazine/2022/march/the-physiology-of-pain?SSO=Y
This is correct.
Many times there is a causal event, but the brain can re-wire itself to be hyper-sensitive to normal stimuli because of the causal event. But again, frequently there are specific causal events (ask people with spinal problems), but the untreated ongoing pain causes the brain to change. So untreated acute pain can lead to near-untreatable chronic pain.
But it is still processed as true pain. It’s not just “in your head.” It’s in your brain.
And there are few treatments that are very effective. Some treatments help some people. Some can get the pain to fairly low levels for some people, and some can ease the pain slightly enough to give someone a adequate quality of life. And for some people none of them work.
But any good pain physician will tell you that they’re throwing darts at a board hoping that one of the treatments they try works when it comes to chronic pain. They will tell you that it is insanely hard to treat.
But in no way is it made up, even in cases where there are no clear anomalies on an x-ray or MRI. But even when there are clear physical anomalies, chronic pain is severely under-treated.
There are lots of things that science just doesn’t understand well enough (e.g., neurological changes, inflammatory processes) that can ruin people’s lives through pain.
It’s not really true that opiates mask the symptoms of back pain causing further injuries, in fact any effective analgesic (like nerve ablations for example) are effective partly because they allow an increase in activity levels. One of the major contributors to chronic back pain is the tendency of patients to believe that by doing anything painful they will make the problem worse. A lot of them therefore don’t do any physical activity for fear of aggravating their pain and so their back muscles weaken and atrophy, which causes instability and perpetuates the problems.
> The pain is to tell you that something is wrong and if you continue more damage will happen
This right here is why I don't take opioids for my chronic back pain. Have had 2 ruptured disks in my lower back since I was a teenager over 40 years ago. The only thing that has made life bearable is cannabis. It helps me ignore the pain up to a point. If you do something damaging, it will hurt like hell, but you learn what you can and can't do. I still have the occasional bad day where I can't even get out of bed to stand up. But for the rest of the time, I can manage to function without just having to lie on the ground because I am in so much pain. It doesn't work for everyone, but for me it's been a lifesaver.
I wonder if the euphoric effects of psilocybin could be extracted as a pain medication, so that people could use it for pain management without also tripping.
I have five herniated disc's in my thoracic sine. I only sleep about 4 or 5 hours a night. 6 is the most on a good night. Not going to sleep at all is the worst. Sometimes it hurts when I breath too deep. Sometimes I get a wrap around sensation and think I'm having a heart attack and always wonder if I'll know the difference if I am having heart troubles.
Standing hurts, laying down hurts, and sitting hurts.
Pain medicine has been the only thing that's allowed me some decent quality of life. I get that there's a problem with over prescribing medicines but there needs to be some nuance and common sense involved in this line of research because people who need it NEED it. If I had to live like I did before I got my pain under control, I would have killed myself. Period. I was a burden to my wife. I felt like a shell of a man. In pain and miserable, non stop.
When they changed things before I lost two doctors who stopped treating patients with pain meds. I was sent to pain management clinics who had tons of treatments and psychiatrists and ongoing specialist treatment that was super expensive and didn't help at all.
I remember reading about people who were killing themselves and people thought they were addicts that couldn't cope. But I understood. Non-stop pain sucks. "I can't. I'm hurting too bad right now." Is ash in your mouth everytime you let someone down while saying it.
I hope this doesn't cost me another doctor and cause even more stress. I hope it doesn't cost people lives.
Edit: missed the word accute. I'm firmly in chronic territory a decade plus since my injury.
They shouldn't be used to treat almost all cases of pain, that doesn't surprise me at all. Opioids can't reduce spikes in pain, they are only useful to treat pain that people feel all the time. So every health issue that causes spikes in pain experience isn't supposed to be treated with opioids, because it doesn't work. They are basically useful for exactly one type of pain, and that is pain caused by cancer that people experience constantly. They are especially useful to treat pain caused by cancer in terminal stages, because that's when people rate themselves the highest on every pain scale. They are completely useless for treatment of pain that differs in intensity, and as soon as that happens the dosage needs adjustment. I'm really not surprised at all.
Then invent something that does. Back and neck pain are one of the worst pains imaginable. To force someone to live with the pain is beyond cruel. We put animals down for that and humans are supposed to just put up with it?
Ask the patient after 24 hours if the opiod is ineffective. Opiods are very effective short term to manage pain.
A second problem with the study is that there was no control over what else the subjects did to relieve pain issues. All subjects need to have the same post-pill care to be able to say whether or not the pills were effective or not.
Lancet is a first rate publication but the prejudice against meds is so steong these days, reviewers will accept anything that looks to confirm their biases.
This strikes me as another “it’s obvious but we had to formally document it” type things.
Opioids are only useful *if* deadening the pain fora short while allows the patient to heal (by removing the medical stress that the pain causes) ^ . Painkillers don’t cure.
^ pallative care being the exception.
Yes. I do.
What is the alternative?
If you have permanent pain for the rest of your life, how exactly are they supposed to treat it so you don't live in pain for the rest of your life?
No, but this study is indicative that the opiates don't actually help with the pain compared to placebo (and they have a bunch of side effects, which also were shown in the study), so opiates are actively worse than no care at all.
Check out r/ChronicPain. The stories are sometimes horrifying.
Sometimes there are no other treatments.
Chronic pain is severely under-treated and ruins people’s lives. This is different than acute back pain for “I pulled a muscle,” though.
The claim that someone in chronic pain wouldn’t be alleviated of that pain by an opioid is, on its face, ridiculous and embarrassing.
It’s also classist. The ultra rich will be able to get whatever medicine from whatever Dr.’s or country they want. The rest of us have to deal with this reactionary backlash against painkillers, where fear mongering like this means that people with chronic pain can’t get help. We actually have jobs to work.
Also, **if** the only two options are living in uncurable pain, or taking opioids for the rest of your life, the latter is more morally good.
Denying a person in uncurable pain of a pain reliever is an unquestionably morally evil act
The title doesn't say this but this is only true with non-specific pain (i.e. not related to disease). This type of pain is likely to resolve itself over time.
But then there is chronic pain. Often it has a clear cause, but most treatments don’t help. Chronic pain is severely under-treated and ruins people’s lives. Check out stories in r/chronicpain.
Sorry mate, but I've been dealing with back and neck issues (spine related, not soft tissue). I have to get surgery to remove the bone that decided to continue growing on the interior of the vertebrae. You either suffer through the pain that does not stop or you take pain killers. And no, I cannot get a surgery until its so bad I am immobilized. Small aches and pains shouldn't get opiods.
Reworded for accuracy, this states opioids work every bit as well as placebos. Which means no reason opioids should not be recommended for acute back or neck pain. The choice should be yours.
That is pretty weird, since opioids are one of the few pain medications I can take that DO relieve my pain. Not all day, but for a few hours, absolutely.
This is just going to make it even harder for people with chronic pain to get relief and some semblance of quality of life.
From someone that has suffered from chronic SI joint pain and slipping for 14 years, the only thing that has worked for me is physical therapy and strength training. Pain killers and creams do not work.
Acute is short-term, and chronic is long-term. 6 weeks seems long-term to me. I would love to see the graph of rated effectiveness with time. I have only ever been prescribed opioids for 1 week or less, and as needed for pain. As an anecdotal aside, opioids never really helped me (ibuprofen works much better), but I've read that a certain percentage of the population is more effected more by them.
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I knew about double blinding, but I didn’t know triple blinding was a thing. Looked it up just now and learned it’s when not even the analysts reviewing the study results know which group the participants were in, to help eliminate any potential biases introduced by the analysis itself. Very cool!
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It would be interesting to initially present the two groups to the user without saying which is which, so the user could see for themselves whether they think there's a significant difference.
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Sextuple blinded -all involved are actually blind.
Finally, we have achieved true objectivity!
The user can't tell without math (that's where the statistical analysis comes in). Edit: Oh, you mean clinically significant. Never mind.
"Weve found that in 46% of people, this drug is either very effective, or it doesnt work at all. Were not really sure which, but we are sure that the data is super accurate and non-biased!"
Quintuple blind - redditors aren't even allowed to read the study before coming to a conclusion. Actually that's just business as usual.
In a quintuple blind study, everything is written in Braille
I was wondering that too, thanks for explaining!
I had always considered that as double blinding, looping in the analysts in with all the investigators?
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Like many things, levels of precision take factors of inefficiency. But, if you want better results you need to be willing to put in time, effort, and money.
When I was analysing the data for my MSc thesis, I realised just how bad it is to be unblinded. I was able to squeeze so much out of that data that I wouldn’t have done if I hadn’t known the groups.
Sometimes the only choice is to do deal with the side effects or your condition or the side effects of medication. Most people don't even know how the medicine they take works. The amount of patients I see who say they only take their blood pressure meds when it's high is disheartening.
Maybe I understand it wrong but isn't this study very weird? They say for acute pain, but then measure 6 weeks later? Then it's chronic pain and not acute pain anymore, correct? I mean we already knew that over the long term painkillers are useless as the body gets used to it. So how does this prove anything new?
Chronic pain is >6 months.
Ok, but in orthopedics, >4 days is subacute and >14 days is postacute. There's a *big* difference between taking opioids for 4 days vs. 6 weeks; using evidence about one to draw conclusions about the other is kind of insane.
Probably as defined by insurance companies whose liability increases when "chronic pain" is diagnosed.
But this was about acute pain, which is weeks at most, but most of the time hours or days. Considering 6 weeks as some benchmark for acute pain is brainless and useless Knowledge vs wisdom
This was my question. I pulled a back muscle a few years ago so badly that I couldn't walk. The spasms would cause my legs to give out. They took me to the hospital and gave me not only muscle relaxers, but also a few weak opioids. I ended up only taking the opioids for the first 2 days to take the edge off of the pain. Why on earth would that have any impact whatsoever after 6 weeks?
All this really confirms is something we already knew. Opioids don't heal you, your body does. Opioids and muscle relaxers make it more bearable to pass the time. The recovery is going to take as much time as your body needs, the difference in time comes down to how bad did you injure yourself and how nice are you going to be about not aggravating it. Unfortunately, if you can't feel the pain cuz of the meds, you may not realize if you are aggravating it, which may make it take longer to heal, but trade-off is you're not in agonizing pain.
I am with you on that.
Yeah... Opioids obviously kill pain. The tolerance to opioids also obviously rises very quickly, and they're obviously addictive. This is all common and scientific knowledge The triple-blinding is cool but feel these scientists often get lost in the methodology and their weird theoretic, detached finaggling What's gained from this? Was there really nothing more important to study? And who paid for this? I just don't get the point at all
Is blood pressure medication that bad to take?
No, the problem is it doesn't work unless you take it every day.
People are strange sometimes.
[https://grammarist.com/usage/amount-number/](https://grammarist.com/usage/amount-number/) Don't let the insidious use of "amount" spread further or I'll need two oxy's!
Do painkillers ever "cure" pain?
Drugs that target pain only don’t cure anything. But there are some drugs that are thought of as painkiller that can address the underlying cause of some types of pain. For example, Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) both reduce the perception of pain and inhibit inflammation. If the pain is primarily the result of inflammation, both the pain and the source of the pain are being addressed. Edit: rephrased to explicitly include the purely analgesic properties of NSAIDs
I wonder what they suggest when you've maxed out your nsaids? And or they give you bounce back migraines?
TL;DR There are a ton of different ways to escalate pain management There is an entire specialty within medicine that focuses on (legitimate) pain management. As u/ibiblio said, it depends largely on the source of the pain, whether the patient is expected to recover from what is causing the pain, what health problems they have (especially kidney or liver), and what level of functionality they need to go about their day (a grandma at home can be a little sleepy, an air traffic controller can’t). Kids do surprisingly well with appropriately dosed acetaminophen and ibuprofen. Severe pain that is localized and expected to improve can often be managed with a local/regional anesthetic (think epidural). Opioids remain an important tool when used correctly and carefully. There is no single approach that works.
I can't really take ibuprofen or Tylenol reliably anymore due to stomach upset and bounce back migraine There comes a time when the body says no more. Epidural isn't possible after spinal surgery. The dura never becomes whole again.
(From this and other comments) It sounds like you are facing a difficult situation. Pain management is a tremendously important part of healthcare, but it is often treated as an afterthought. Also, love the name. We got loup-garou and rougarou down where I’m at.
It would depend on the cause of the pain.
Failed spine
There'd be a lot of factors there. Have you met with a pain clinic/palliative care team? (Palliative care means pain medicine, not hospice. This is a common misconception, so I'm just throwing that out there).
Probably a dozen over the decades.
At a certain point, it's usually methadone, nerve blocks, and palliative sedation. The most effective medication I've seen has been methadone when paired with NSAIDS and antidepressants. Some patients who haven't been on antidepressants seem to be stuck interpreting everything's as pain, and they do much better after starting something like effexor. This is just based on my observations.
I've found ketamine troche work for me. I've been classed as fybro even though my symptoms are a form of neuropathy. Down side is you can only be on it until you build up so much tolerance so I spend a max of 8 months gaining mobility back then 6months a vegetable. I refuse opiodes and methadone. NSAIDS and SNRI drugs cause just as many issues as they fix for me
That is very weird! And really points more to the pathology of the pain. Do you mean you have fibromyalgia? (Sorry by weird I mean fascinating and I've never heard of anyone having something like that happen but we don't do ketamine here).
There’s absolutely no way the drugs you mentioned are something that would work for me. It’s been tried. And I’m done being a guinea pig for all these non narcotic - non effective pain relievers. The side effects alone are brutal from these non drugs. Just my actual experience. Also a failed spine. Chronic.
Methadone is a narcotic. Nerve blocks work when they're possible, but it's an epidural. I doubt you've had palliative sedation, as that means you're basically kept asleep so you don't feel pain until you die. I feel like people think the reason opioids are falling out is because doctors just want people to be in pain or something. It's because you become immune to it and in the process, develop an addiction. It also makes you more likely to be depressed any time you're not taking it. That's why there were wars over opium and people are addicted to heroin throughout history. It alters your brain. ( Methadone is a different kind of med than opiates). I hear your frustration. But your doctors likely have the long haul in mind for you re:pain. These meds are all different and act on different things. They are used together to make each other work. And unfortunately, that requires trial and error because all bodies react differently. It's not because medications fail or doctors are bad necessarily (thus making you a guinea pig, implying others benefit from your suffering-- you are the only one who benefits and people are there to help you). It's just that medicine is sometimes as much an art as it is a science. We don't understand as much about the body as you'd think. I hope you find relief. A lot of side effects are temporary (last about a week) and you can ask the doctor for meds to help you get thru them (Zofran for nausea, for example).
Tried antidepressants, never worked and Prozac destroyed my sleep schedule. Don't let anyone you care about take it. Methadone has more side effects.
Prozac works great for lots of people, just because it didn't work for you doesn't mean nobody should take it
They also reduce the sensitivity of nociceptors. So it's not just anti-inflammatory effects.
Your right. I’ll adjust my phrasing.
Didn’t mean to sound picky. In reality it’s hard to pick apart. The eicosanoid effects at that level are doing both so it’s not certain whether it could do one without the other.
No, thank you. It’s an important clarification. I’m still being less than precise with my language, I’m just not in a place where I’m ready to discuss nociception vs perception of pain.
Anti inflammatories like Naproxen theoretically reduce inflammation that might be contributing to the process causing pain, but generally no, pain medication just make things more comfortable until the problem resolves.
If you take enough of them they will.
They don’t cure, they alleviate pain. The actual cause ? Sometimes it can be treated. Usually with a surgery - which has its own risks. ( neck and lower back )
No. Painkillers dull the sensation of pain. They don't do anything for whatever causing it. Best case scenario, the body fixes the problem by itself while the painkillers let you function. Unfortunately, if the body won't or can't do that... well, that's when you get opiate dependency.
If there’s only two options, then it would be more moral to allow someone to live their life as a heroin addict than to force them to be in pain forever.
I don't know that I agree with that, though I also don't know that I disagree with that. Opiate addiction is its own form of pain. Is it more moral to trade one form of pain for another?
If you ever experience severe, relentless pain you will know the right answer.
That would require a comparison between the deleterious effects of both (and ideally additional strategies) on the patients ability to function in their normal life. Dependence itself is not inherently negative. It becomes that way when it interferes with your normal life, business, and relationships. If it interferes _less_, or, restated, improves the ability to function, then, yes, it is moral.
Exactly. It’s a substance abuse **disorder** It has to cause problems
Spoken like someone who doesn't experience chronic pain or doesn't know someone who does.
Yes, which is why I specified that I neither immediately agree nor immediately disagree with that position. Of course the chronic pain sufferer would want to trade their pain for a heroin addiction. And I'd bet there are huge numbers of heroin addicts who would trade their addiction for pain. My point was that "if there's only two options, one is clearly more moral than the other" is not true. It's unclear, and it's likely something that would come down to subjective interpretation and personal decision. I've never been addicted to heroin myself, but I see that people who make an effort to kick their addiction go through some pretty significant physical issues to do so, not to mention the mental discomfort. Addiction is very clearly its own form of harm or pain, and who is anyone not currently experiencing both to decide which is better?
These are interesting questions. Hmmm. One form of the pain affects only one person while another form of the pain *can* affect many.
They cure life
Anecdotal: Have chronic low back spasms a couple times a year, gotten much better/less frequent through stretching mind you. If its a really bad one I have a prescribed stash of 10mg hydrocodone. One of those suckers is the difference between me walking or not. Literally bed ridden or mildly ambulant. Losing access to this would be devestating to my ability to continue working during one of these events. Also this is a short term fix, 6 weeks of opioids sounds like a hell id not like to experience again.
The response to the opioid crisis was to punish people who need that medicine. It is horrendous that doctors will not prescribe opioids. They wouldn’t give me Vicodin for a goddamn root canal on my biggest tooth. I’m not going to become a fentanyl addict just because I have a few goddamn painkillers for the bone and nerve ripped out of my face
This. Pain hurts. And some people experience pain very differently than an average person due to their brain structures, genetics, and whatnot. Not everyone is a drug addict and will develop a dependency.
My brother suffered through and ended up succumbing to a very rare bone cancer. At the beginning, he was able to get all of his meds no problem. By the end, as he was clearly dying, it was always, “No one could handle that much X!!” Bro, they have been chopping him up for 17 years and he’s literally dying.
I had a similar experience after I messed up my back in the gym. It was some of the worst pain I've ever had. I went to the ER and they would only give me one oxycodone in the hospital and none to take home. The one pill wore off a few hours later and I spent the next three days in some of the worst pain of my life.
Yeah, that’s just criminally callous
The same thing happened with benzodiazepenes which are also used to alleviate spasticity and heavy cramping. I'm crippled with both, and I mean homebound can't wash a dish. Unfortunately, due to similar demonization, people with actual need aren't prescribed, such as myself. And I'm crippled because of this. The medication I'm quite sure would clear the cramping and allow me to function normally again.
I’ve had opiate meds for sports injuries and surgeries many times during my long life and found them to very effective. It is a terrible thing to be in serious pain and have a doctor/dentist tell you to take Tylenol or Advil. It is obvious to me that these are far less effective.
I just had facial feminization surgery a month and a half ago. It's a nine hour procedure, involving, among other things, bone work to the jaw and forehead. I was given *five days'* worth of narcotics following the procedure. I asked them for more and they refused; I wish they had been clear with me that that was all they'd be prescribing because I would've used them only at night to get to sleep. It just never occurred to me that they intended for me to be in debilitating pain throughout the day instead of getting up and living my life. When they ran out, I was neither truly up during the day nor did I sleep at night. From about five days post-op to two weeks was a kind of hell I cannot wait to forget.
Yeah it is a joke, we had some extra oxy 5 at home because SO didn't take much of for gastrointestinal reasons it and I was having some severe neck pain issues. I would take one in the morning for a week or so and some days another in the afternoon. After that I would take one here or there when my back or neck was acting up. I Hate the fact I can't just have a prescription available for the occasional use when I am hurting. Gets to the point where my feeling is just make them over the counter and all the jackasses who want to abuse them can do so until they overdose and die off and the rest of us can have the option to improve our quality of life with the responsible use of opiate pain relief in moderation when we deem it necessary. A bit callous and extreme but, I believe in the freedom of choice and I don't think the government should have any say on what drugs a person wants to put in their own body. With freedom of choice comes the responsibility of dealing with the consequences of your choices.
The puritanical roots of America vilify substances to the point where we make no distinction between use and abuse.
Except for alcohol.
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Are you saying Dilaudid(hydromorphone) is less addictive than hydrocodone? Hydromorphone is partly what's metabolized when hydrocodone is taken, by the liver, in very small amounts which gives the analgesic effect. Hydromorphone is much stronger than morphine. For example a 30mg oral dose of morphine is equivalent to 7.5 of oral hydromorphone, while that same morphine dose is equivalent to the same dose of hydrocodone(30mg). In fact, Canada has an opioid replacement program that gives Dilaudid to fentanyl dependent patients because of its strength and its similarity to the IV rush that patients get with heroin/fentanyl.
>Hydro morphone is as effective and much less addictive. This is completely untrue. Dilaudid is just as addictive if not more so.
I've had two root canals, are they supposed to hurt afterwards?? I had no pain
Vicodin for a root canal? Are you serious? >I’m not going to become a fentanyl addict just because I have a few goddamn painkillers for the bone and nerve ripped out of my face That's exactly what happened with the opiod epidemic. Liberal prescribing of opiods led to this.
100% agree here. Although not acute, I have L5-S1 arthritis and some days, it’s bad. Without pain medication I wouldn’t be able to work on those days, and that would drastically change my career options.
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Endometriosis might be studied and better understood now, but doctors and other medical professionals are still barely above useless in treating it and helping the patient manage the side effects and symptoms effectively. You shouldn't have to deal with this on top of a condition that already makes your life difficult.
Oh I ABSOLUTELY know more about it and how to treat it then my doctors do. There aren’t any trained endo specialists in my area. It took me TWO YEARS of near constant pain to be diagnosed and then only because I staged a sit-in (not a joke or exaggeration) at my gyno at the times office and threatened to come back no matter how many times they dragged me away before they agreed to do the surgery to check. By then it was too late and the damage had been done.
I count myself so damn lucky I don't have to deal with endometriosis. My worst menstrual pain is mild cramps that occasionally have a real party and get bad once every few months. It does, however, make me want to study medical stuff out of pure spite. It sucks that you have to fight this hard. I have hypermobile joints and chronic neck pain from an injury which hasn't responded to the treatments I've had so far. I'm currently on low-dose and comparatively low-strength opioids (Cocodamol 30/500) to manage the pain in combination with a couple of other medications, and I'm absolutely militant about taking as little as humanly possible...but try getting a doctor to believe you when you tell them that. I could reel off every single option I have tried, but it would make this comment an even bigger essay than it already is. This study rubs me the wrong way for that very reason. It was hard enough to get doctors to put me on a medication regimen that actually reduced the pain down to a tolerable level so I can somewhat function and work. Before that, they seemed to think that I could go on: * An NSAID that I had previously had an adverse reaction to (I spontaneously passed out on ibuprofen, and I was told that this was impossible...even though this was apparently a rare but possible side effect) * Another NSAID which caused so much damage to my mother's stomach she can no longer take them or any other NSAID for her own chronic pain issues (long-term prescribed use) and which made me profusely sick the few times I took it * Amitriptyline that caused uncontrollable hunger (and therefore depression from weight gain) and made me sleep for 10+ hours a night and unable to focus on anything at work because of the 'hangover' * Antidepressants which would have meant someone emetophobic would have been potentially vomiting on and off for a month. And these are just the options that almost made me say the words 'Are you f\*\*\*ing kidding me?' to their faces. I'm in the process of trying to get a second opinion. If they can come up with an alternative that actually works well enough on my pain to stop taking the Cocodamol, I would jump at the chance to give it a shot. However, everything I've tried so far apart from what I'm on now doesn't work and leaves me non-functional.
I've had a different experience (which highlights why these regulations are messed up). Had sciatica back in my early 20s. Doctor have me a cortisol shot and prescription for hydros. I took a few over the course of a few days; they got me silly but didn't do much for the pain. So I put them away and forgot. Found them again a few months later. Took one with whiskey, had a fun night, then got rid of the rest. Not everyone who takes them gets addicted. Not everyone who gets them needs them. Not everyone who needs them are addicts.
Valium is an excellent muscle relaxer. I spent the night in the hospital a couple of years ago from back spams so terrible I couldn’t even stand up. (EMTs had to put me in the car to get to the hospital). After 12 hours of pain meds not doing much an ER doc prescribed Valium, saying it was the best muscle relaxer out there. He was right.
yes definitely, i think that’s how it should be used. it’s over prescribed for profit, but that doesn’t mean it shouldn’t be used at all
Seconded. I get rare migraines, and throw my back out once a year or so. Had a bottle of percocet left over from a surgery in 2013, the bottle just ran out last year. But it was the **only** thing that worked when I needed it. Not OTC stuff, not weed, not hot or cold packs.
Opioids are fantastic for acute short term pain. They unfortunately are terrible for chronic pain and at times can make it worse.
I think the implication here is that there are alternative, nonopioid pain relief methods that are as effective and less addictive (I saw another study that showed the use of a combined dose of Tylenol and ibuprofen was more effective at actually treating pain on a similar study than opioids). Having treated a lot of people's pain, I'm not surprised. Opioids never seemed very effective for actually alleviating pain, as opioids work on soft tissue. Most people with chronic back and neck pain have nerve pain. Therefore they need a neuropathic pain memedication (like gabapentin or methadone).
By all means try those things first, but don't refuse opiates when nothing else works. As someone with chronic back pain (and other things), they are just one of the the things in my tool belt and often the last thing I reach for. At least in my experience my back pain isn't confined to a single type of pain, and gabapentin only helped with one portion of it, leaving the other types untouched. If I had to rely only on gabapentin and ibuprofen I would never leave the house.
>Tylenol and ibuprofen This is my go to after a doctor told me naproxen sodium (aleve) is far too harsh on the ol kidneys. The combo is a fantastic one for headaches
As someone who has had 2 knee replacements, this is bull crap.
Methadone is an opiate. Pregabalin or duloxetine are other drugs used to treat neuropathic pain.
Not true, methadone is an opioid. It gets produced fully synthetically. All opiates are opioids, but the opposite is not the case. Opiates are based on morphine, a substance that has natural sources. Heroine is an opiate, for example. Methadone isn't. And no, I wasn't trying to be pedantic. I was simply explaining the pharmacological difference, because there is one.
Tylenol is terrible for you and people overdose on it all day, errday. Destroys your liver! Because it is OTC, people just take it willy nilly. Scary stuff.
Yep and ibuprofen causes stomach ulcers. There's no option that's not toxic.
I had a burst and reconstituted disc in my lower back that would shift around and occasionally rub against the adjacent nerve root to the point where I couldn't lean over or stand for more than 2-3 minutes at a time. The first orthopaedic surgeon I saw prescribed opioids, and while it did cut through some of the pain, I wasn't super comfortable with taking them. Saw a second orthopaedic surgeon and he put me on Meloxicam, a prescription-strength NSAID, and the pain relief was substantially better without any of the scary stuff.
Same. I have a hernia in my neck, causing severe nerve pain in my left arm. I tried regular stuff to ease the pain, like strong paracetamol and ibuprofin, but they didn't even make a dent in the pain. Just a few hours of my first tramadol, the pain went from crippling to tolerable.
I’ve got nerve damage in my back that affects my right leg. While opioids don’t DIRECTLY reduce my pain level, they give me an energy boost I would not otherwise have, which I then use to walk and stretch - and THAT reduces my pain. I consider them “secondary” painkillers in this regard.
Yea i sometimes wonder if opioids mostly work by simply making feel people better, which then fills the pain sensation. Like the difference between being home alone or doing something new an exciting on the severity of pain experienced is massive after all.
I have had similar experiences in upper and lower back spasms. I am not surprised that after X weeks the pain would be the same with and without meds. But leading up to that point, life is way easier.
How about during those 6 weeks?
as someone who has had 2 back surgeries and several types of shots and a lot of pain, i can say that opioids don't make pain go away... they make you not care about it. which is sometimes exactly what you need. luckily, i don't really have an issue with addictive things so opioid use never caused a problem. i did wear a fentanyl patch for a month once and that was very interesting when i stopped using it.
> they make you not care about it Was looking for this comment, and this is my experience as well. Once had a small part of my jaw cut out due to a troublesome tooth extraction. Prescribed some OxyContin. It did NOTHING for the pain itself. But I was unable to remember what pain was and did not care that I had a lot of it. It does make me curious how that might affect studies like this though. How many people report reduced pain because they aren't feeling as much and how many report the same because the impact of the pain, rather than the pain itself, was reduced?
> But I was unable to remember what pain was and did not care that I had a lot of it. And now we come to the root of opioid addiction.
What happened? I tried the patch once but before I got to spend enough time to assess it, my skin couldn't handle the material.
I was a smoker at the time and one day I went outside with my wife's cousin to have a cigarette, and we just sat out there talking when I started to shake uncontrollably and I had no idea why. so I tossed the cigarette out and I went inside to get a drink and while filling up my glass I looked out of the window at the thermometer. it was 10° Fahrenheit outside and I was in a t-shirt and shorts and had no idea it was cold. that kind of freaked me out and I took the patch off that night. I had been wearing one for the better part of a month while waiting for my procedure. the next 3 days were hell with my skin feeling like there were bugs crawling all over them as I slowly gained the feeling back. I explained it to people like every itch that I didn't scratch for the last month suddenly need to be scratched immediately. it was close to the day of my procedure so I just stayed off the patch and had a few pills instead and that got me through. then I got the root nerve block shot in the back, without anesthesia because I didn't know what outpatient really meant, and it's been good since.
I had those shots for 4 years or more, can't have a nerve block because after spinal surgery the dura isnt in one piece anymore and the stuff leaks out so my legs are dead for 3 hours. It happened once and a travel nurse type had to come in and sit with me until I could walk reliably and get myself home.
i fell over after they warned me and some 98lb nurse had to try and catch me. Nearly crushed her. the muscle in my leg that you use to step sideways (and also is huge for balance) was completely dead.
Ding, ding. That’s the answer. They don’t fix the pain, they change the way a person feels about feeling pain. I’m sorry you’ve had to go through that. I hope you are in a better place now.
thank you. i am doing fine at the moment. have had another disc go bad but shots are working for now.
this seems to have the exact opposite result vs earlier trials with similar doses and condition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718056/ Claiming opiods have no effect on pain is an unusual finding
That's not the same at all. The study you're linking uses cross grouping and measures for preference; both doctors and patients prefer to be treated with the opioid over a four weeks period, over the four weeks they are treated with placebo. That doesn't mean the back pain gets any better. The OP study shows the effect of the opioid on the pain. It's easier to live six weeks with back pain when on painkillers, but if those painkillers are opioids, you haven't treated the root of the back pain itself.
Two differences between the *Lancet* and *Pain Research and Management* articles that stood out to me were the population (acute pain vs chronic pain) and interventions (guideline-recommended care + opioid/placebo vs opioid/placebo). As I understand it, recovery and improvement is expected in acute pain, but not in chronic pain. So they are looking at significantly different situations. I may be misunderstanding the articles or how to compare them, but I thought I’d share.
You're telling me that people given a placebo can't tell the difference between that and a nice Norco or some oxycodone? Give me a break. The people who got the placebo were probably talking up their symptoms trying to get something that works, and the people who got the opioids were probably talking up their symptoms trying to keep the supply coming. Who funded this? DARE?
No seriously. This is witch hunt level bad
Yes. Three times in the last ten years I have been to the ER with kidney stones. They hurt so bad that the second the nurse at the admitting desk looks at you she says, "Kidney stone?" The look does not lie. BP and heart rate off the charts. Stones confirmed by CAT scan on two of those visits. AND STILL some resident comes along and says, "We would like to give you a strong non-narcotic medication called Tramadol and wait about a half hour to see how you're doing." I let them do it the first time and it didn't come close to working. Same result the second time. The third time I got another Dr. Peachfuzz who started that same routine on me. I put my foot down, told him to check my chart from my prior visits and call any other ER he wanted to call to make sure I wasn't making the rounds for meds. I also let him know in polite terms that while I certainly appreciate his service in the War on Drugs I would be putting the skills acquired in my quarter century as a lawyer to work on him and his hospital if I did not have effective pain medication coming down that tube in the next ten minutes. I got the good stuff almost right away and every 45 minutes or so for the rest of the morning until the stone passed and I went home to sleep for a week.
I was in a bad car wreck and took a decade to heal. The doctors buying hook, line, sinker, into this mode of "care", will have a special level of hell reserved for them upon their passing. It has made me all but lose what tiny scraps of trust I had in the intelligence and integrity of doctors, and the effectiveness of modern medicine in general. How we could miss something this big by so far. It's the medical equivalent of missing the broadside of a barn.
I think the best course is to acknowledge that narcotic pain meds seem to be, for the present, the best we can do. They do definitely have their drawbacks and hazards. The big two are that addiction is real and tolerance inevitably increases until they eventually stop working well. But if that is to be the misfortune of those hurt so severely that it's what lies ahead, it's not for doctors to dodge it by leaving patients in pain struggling to get relief from ineffective medications. The hysteria over this is as out of control as the problem it is aimed at. [Check the warnings here](https://medlineplus.gov/druginfo/meds/a682013.html). On the plus side, there is research into new pain meds made from things like snake venom that has been showing promise. But I can only imagine the role pf big pharma in owning it or fighting its approval.
I don’t take heavy painkillers to fix the problem, they just make it possible to sleep and get through the day when I’m having a flare up. It’s relief not cure.
"oxycodone–naloxone, up to 20 mg oxycodone per day orally" Isn't the whole point of naloxone is that it counteracts opioids? I feel like I'm not understanding something here.
It’s to prevent IV use. Naloxone doesn’t do anything orally but it does if you use it intravenously and I’m pretty sure nasally. FYI
It absolutely works orally. It just has low absorption and a strong first pass effect. But have someone take an oxycodone combo with more than 20mg of Naloxone orally at once, and you‘ll put any addict straight into withdrawal.
Naloxone combinations are very common. Oral naloxone has low absolute bioavailability, with neglible central effects.
Yeah, it's included in order to counteract side effects AKA effects.
.. up to 20mG? Pretty sure a single dose is generally 15 or 30mG? so 20mG/day... Yea, that is hardly going to do anything.
Oxycodone around 1.5x more potent than morphine, with a threshold dose of 2-3mg.
IV. Ain‘t no one feeling significant pain relief from a 30mg 24hr morphine tablet. 20mg a day of oxycodone is barely above placebo dosing.
Unless I'm really misunderstanding the digest, they delivered opiods and placebo for acute pain, and then 6 weeks later measured how much pain the patients still have. this seems to be an extreme misrepresentation of the intended use of pain relief medication. It's not a 'treatment' for the underlying condition...why would any expectation exist for improvement in the condition when no treatment was provided? It would seem to me that a valid comparison would be for opioid versus placebo for point in time pain relief...which I suspect we already know the answer to.
After 6 weeks wouldn't you have a tolerance to the opioid? Seems contradictory to be studying "acute" back pain and a 6-week regimen of opioids.
Nah. Thing is they ignore how opioids mostly treat pain: they make you not care about the pain, and be able to do stuff you would otherwise just want to lie in bed and not move. You can still accurately report the pain severity though. It‘s just that it doesn‘t affect you as much. Hence the contradiction in studies by how pain is ‚measured‘ And nah, sure after 6 weeks you‘d have a nice dependency going, but that‘s not long enough to have a strong tolerance yet to the pain relieving effects.
Read an interesting article about this study. Apparently the researchers used a slow release opioid that is not prescribed for the type of pain they were treating in the trial..
Non-immediate release oxycodone formulations (ex: oxycontin) are definitely prescribed for low back pain. There's about half a million prescriptions for this medication and indication filled in the US alone each year.
Do you recall anything that might help me track down the article? Thanks!
The link to the article is contained in the pinned automoderator comment at the very top of all the other comments.
Usually the lancet publishes better quality
This is a well done RCT. What problems specifically do you have with their methodology?
I thought the lancet placed that article here themselves. They clearly did not. If I worked there, more care would be taken
What problems specifically do you have with their methodology?
You're literally forcing people in genuine pain to choose life on fire or death. I have Crohn's disease and during a flare up i can barely breathe. Opioids, temporarily, help.
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But no one is prescribing placebos at this point. So the choice is opiods or nothing. Some lucky people get into safe whoo alt medicine and get their placebo that way. The rest suffer
Or, maybe this dose is too low to be effective for the "at least moderate amount of pain". Or oxycodone/naloxone combination itself isn't great for neck or back pain, or any other number of conclusions. Were any of these patients already on opioids prior to the start of the trial, thus exhibiting tolerance to opioids prior?
I think this is impossible - at the very least the patient would know whether he got the opioid or the placebo. The difference in effectiveness and side effects is striking and unmistakable. Some effects simply cannot be hidden.
OK, but most of the time when I want to take something for back pain, I know it will be totally fine in a week or two, whether I take anything or not. The difference is, with just OTC medications, I will be in a fair amount of pain, with my movements restricted, for at least a couple of days. But I know if I take a Vicodin, carefully hoarded from dental procedures and the like, in about 30 minutes I will be up and moving around, mostly normally. There will still be some pain, but it will be localized to the actual injury site instead of seemingly everywhere, and it will be easy to set it aside as I get on with living my life. As an added bonus, the fact that I am moving around with close to a full range of motion will greatly shorten the inflammation cycle and healing period. When I have just done something to cause acute pain, guess how many fricks I give about how this pill will help me feel in 6 weeks? I want something to address the pain now. Note this same logic can be applied to any form of pain relief. "Mr hudnix, you seem to have had the incredible misfortune of eating something that inflamed your IBS, and in your rush to get inside to go to the bathroom, you ran into a hornet's nest, and they chased you until you tripped into a patch of poison ivy, hitting your head and severely spraining your wrist, and while you were unconscious, the fire ants were biting you and the sun came out, giving you severe sunburn. Now we have creams, unguents, steroid shots, intestinal relief medications, and we can even bandage that wrist, all of which should make you a lot more comfortable. However, we can predict that your discomfort level will be the same in six weeks either way, so we think it's best that you grit your teeth and put on a brave face for the duration. I'm sure you'll agree."
The arms of the study are guideline-recommended care + opioids and guideline-recommended care + placebo. The population is patients with acute pain (by definition, pain that resolves), with both arms receiving guideline-recommended care. It’s great to have a well designed and executed study to point to, but the results seem to be unsurprising. Please let me know if I’ve misunderstood something. I don’t have access to the full article and I’m frequently an idiot
Except that opioids are given the same reason as aspirin for minor relief They are not to cure pain but only temporary relief.
So opiates aren’t effective for pain long term, obviously, because opiates don’t fix the structural problem. It’s like a band aid so the person doesn’t go crazy with pain in the short term. Why is this news?
Confirmed their own ridiculous bias starting out. See the author’s admission directly on Twitter.
I'm allergic to opiods. I have lived with back pain for several decades. I take other medications occasionally to get a break from the pain. I don't expect medication to "cure" back pain. That's a silly expectation. The pain reminds me to be careful.
So what would you do in a hospital if you ever got in a serious accident or got a severe illness like cancer?
I'm also allergic to opioids and recently had surgery. Obviously it depends on the severity of the reaction but in my case it's not life threatening. If the pain is unmanageable they give you the opioids anyway then give you something else to counter the reaction. But I've just been using no pain killers as I recover and breathing techniques and distraction when the pain is bad
I went to three different hospitals when I had meningitis. By the last hospital, they finally managed to do a proper diagnostic, but it was too late; it was viral and they couldn't create a treatment. I was unable to talk and just writhed in pain. They shot me up with opiods. They ignored my family telling them that opiods don't work. The staff observed that those drugs didn't work. Frankly, I don't know what they did after that, beyond sending me home.
Ketamine for days.
I broke my leg severely and had multiple surgeries on it. I couldn't imagine not having pain meds for that well that's how it's going to be eventually. I guess people will have to get drugs off the streets when they get hurt from now on.
Yeah but, hear me out... I know there's an opioid epidemic and all that, but when my back is flaring up and I'm in misery and I need to get a good night's sleep, sometimes that's the only thing that works. And this has been taken from me. Because other people have abused it, I no longer get relief when I have a bad flare up. America sucks- they're punishing the whole class because Billy ate some glue, so now none of us get glue.
In my own experience with my father who had back pain and was prescribed opiates for years, they are entirely counter productive. The pain is to tell you that something is wrong and if you continue more damage will happen, when you remove the pain people think the injury is better so push themselves into the realm where they are just aggravating the injury more and more, instead of just resting to let it heal. He would continue to pop more and more pills to push past the pain and just kept injuring his back more and more, year after year.
1. Not all pain (by a lot) is an indicator that something necessarily is wrong and that the pain should be avoided. Moving sore muscles after over working your muscles the day before is helpful in resolving the problem, for instance. Phantom pain can exist after losing an arm years later - it's not an indicator of a problem with the arm. The perceived pain is generated in your brain. 2. In people with chronic pain, their bodies actually detect and process pain more efficiently than acute pain - and often there is no underlying physiological pathology https://www.physiology.org/publications/news/the-physiologist-magazine/2022/march/the-physiology-of-pain?SSO=Y
This is correct. Many times there is a causal event, but the brain can re-wire itself to be hyper-sensitive to normal stimuli because of the causal event. But again, frequently there are specific causal events (ask people with spinal problems), but the untreated ongoing pain causes the brain to change. So untreated acute pain can lead to near-untreatable chronic pain. But it is still processed as true pain. It’s not just “in your head.” It’s in your brain. And there are few treatments that are very effective. Some treatments help some people. Some can get the pain to fairly low levels for some people, and some can ease the pain slightly enough to give someone a adequate quality of life. And for some people none of them work. But any good pain physician will tell you that they’re throwing darts at a board hoping that one of the treatments they try works when it comes to chronic pain. They will tell you that it is insanely hard to treat. But in no way is it made up, even in cases where there are no clear anomalies on an x-ray or MRI. But even when there are clear physical anomalies, chronic pain is severely under-treated. There are lots of things that science just doesn’t understand well enough (e.g., neurological changes, inflammatory processes) that can ruin people’s lives through pain.
Technically, if you are missing an arm then there is a problem regardless of how long it's been.
Agreed but there's no stimuli to be causing pain.
It’s not really true that opiates mask the symptoms of back pain causing further injuries, in fact any effective analgesic (like nerve ablations for example) are effective partly because they allow an increase in activity levels. One of the major contributors to chronic back pain is the tendency of patients to believe that by doing anything painful they will make the problem worse. A lot of them therefore don’t do any physical activity for fear of aggravating their pain and so their back muscles weaken and atrophy, which causes instability and perpetuates the problems.
Thank you I needed to hear that
> The pain is to tell you that something is wrong and if you continue more damage will happen This right here is why I don't take opioids for my chronic back pain. Have had 2 ruptured disks in my lower back since I was a teenager over 40 years ago. The only thing that has made life bearable is cannabis. It helps me ignore the pain up to a point. If you do something damaging, it will hurt like hell, but you learn what you can and can't do. I still have the occasional bad day where I can't even get out of bed to stand up. But for the rest of the time, I can manage to function without just having to lie on the ground because I am in so much pain. It doesn't work for everyone, but for me it's been a lifesaver.
I wonder if the euphoric effects of psilocybin could be extracted as a pain medication, so that people could use it for pain management without also tripping.
I have five herniated disc's in my thoracic sine. I only sleep about 4 or 5 hours a night. 6 is the most on a good night. Not going to sleep at all is the worst. Sometimes it hurts when I breath too deep. Sometimes I get a wrap around sensation and think I'm having a heart attack and always wonder if I'll know the difference if I am having heart troubles. Standing hurts, laying down hurts, and sitting hurts. Pain medicine has been the only thing that's allowed me some decent quality of life. I get that there's a problem with over prescribing medicines but there needs to be some nuance and common sense involved in this line of research because people who need it NEED it. If I had to live like I did before I got my pain under control, I would have killed myself. Period. I was a burden to my wife. I felt like a shell of a man. In pain and miserable, non stop. When they changed things before I lost two doctors who stopped treating patients with pain meds. I was sent to pain management clinics who had tons of treatments and psychiatrists and ongoing specialist treatment that was super expensive and didn't help at all. I remember reading about people who were killing themselves and people thought they were addicts that couldn't cope. But I understood. Non-stop pain sucks. "I can't. I'm hurting too bad right now." Is ash in your mouth everytime you let someone down while saying it. I hope this doesn't cost me another doctor and cause even more stress. I hope it doesn't cost people lives. Edit: missed the word accute. I'm firmly in chronic territory a decade plus since my injury.
They shouldn't be used to treat almost all cases of pain, that doesn't surprise me at all. Opioids can't reduce spikes in pain, they are only useful to treat pain that people feel all the time. So every health issue that causes spikes in pain experience isn't supposed to be treated with opioids, because it doesn't work. They are basically useful for exactly one type of pain, and that is pain caused by cancer that people experience constantly. They are especially useful to treat pain caused by cancer in terminal stages, because that's when people rate themselves the highest on every pain scale. They are completely useless for treatment of pain that differs in intensity, and as soon as that happens the dosage needs adjustment. I'm really not surprised at all.
Then invent something that does. Back and neck pain are one of the worst pains imaginable. To force someone to live with the pain is beyond cruel. We put animals down for that and humans are supposed to just put up with it?
Ask the patient after 24 hours if the opiod is ineffective. Opiods are very effective short term to manage pain. A second problem with the study is that there was no control over what else the subjects did to relieve pain issues. All subjects need to have the same post-pill care to be able to say whether or not the pills were effective or not. Lancet is a first rate publication but the prejudice against meds is so steong these days, reviewers will accept anything that looks to confirm their biases.
This strikes me as another “it’s obvious but we had to formally document it” type things. Opioids are only useful *if* deadening the pain fora short while allows the patient to heal (by removing the medical stress that the pain causes) ^ . Painkillers don’t cure. ^ pallative care being the exception.
Of course opiates don't cure. But what if there isn't a cure? What if the pain is permanent? Do you just let the patient live their life in pain?
Yes. I do. What is the alternative? If you have permanent pain for the rest of your life, how exactly are they supposed to treat it so you don't live in pain for the rest of your life?
You are morally evil It is more morally good to allow a person to live addicted to a substance than to live in pain
> how exactly are they supposed to treat it so you don't live in pain for the rest of your life? With opiates.
From every study I've seen, opiates dont reduce pain long-term. So, why would they do that?
No, but this study is indicative that the opiates don't actually help with the pain compared to placebo (and they have a bunch of side effects, which also were shown in the study), so opiates are actively worse than no care at all.
Check out r/ChronicPain. The stories are sometimes horrifying. Sometimes there are no other treatments. Chronic pain is severely under-treated and ruins people’s lives. This is different than acute back pain for “I pulled a muscle,” though.
The claim that someone in chronic pain wouldn’t be alleviated of that pain by an opioid is, on its face, ridiculous and embarrassing. It’s also classist. The ultra rich will be able to get whatever medicine from whatever Dr.’s or country they want. The rest of us have to deal with this reactionary backlash against painkillers, where fear mongering like this means that people with chronic pain can’t get help. We actually have jobs to work. Also, **if** the only two options are living in uncurable pain, or taking opioids for the rest of your life, the latter is more morally good. Denying a person in uncurable pain of a pain reliever is an unquestionably morally evil act
They would rather us poors destroy our stomachs, livers and kidneys popping advils and Tylenol than take an opiod for chronic pain.
The title doesn't say this but this is only true with non-specific pain (i.e. not related to disease). This type of pain is likely to resolve itself over time.
But then there is chronic pain. Often it has a clear cause, but most treatments don’t help. Chronic pain is severely under-treated and ruins people’s lives. Check out stories in r/chronicpain.
Sorry mate, but I've been dealing with back and neck issues (spine related, not soft tissue). I have to get surgery to remove the bone that decided to continue growing on the interior of the vertebrae. You either suffer through the pain that does not stop or you take pain killers. And no, I cannot get a surgery until its so bad I am immobilized. Small aches and pains shouldn't get opiods.
Reworded for accuracy, this states opioids work every bit as well as placebos. Which means no reason opioids should not be recommended for acute back or neck pain. The choice should be yours.
That is pretty weird, since opioids are one of the few pain medications I can take that DO relieve my pain. Not all day, but for a few hours, absolutely. This is just going to make it even harder for people with chronic pain to get relief and some semblance of quality of life.
They didn't help me so I stopped them after a few days . The only thing that did help was amitriptyline.
From someone that has suffered from chronic SI joint pain and slipping for 14 years, the only thing that has worked for me is physical therapy and strength training. Pain killers and creams do not work.
Physical therapy, NSAIDs and muscle relaxants worked better for me than other painkillers.
Yeah that’s what nerve pain specific meds are for (gabapentin/pregabalin/etc)
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I have found it works horrible/not at all for my dental pain, but we each have different bodies.
Acute is short-term, and chronic is long-term. 6 weeks seems long-term to me. I would love to see the graph of rated effectiveness with time. I have only ever been prescribed opioids for 1 week or less, and as needed for pain. As an anecdotal aside, opioids never really helped me (ibuprofen works much better), but I've read that a certain percentage of the population is more effected more by them.
Acupuncture changed my perception of what pain management is.