Sunday , June 26 2022

Opioids offer small chronic pain benefits and disappear over time, says study


Those benefits also tend to reduce over time and face the risk of side effects such as vomiting and constipation, according to the review of almost 100 random trials published in the Journal of the American Medical Association. According to the line, risks can include physical dependence and overdose.

"The advantages of opioids for chronic pain management tend to be quite moderate," said study author Jason Busse, a link teacher in the anesthesia department at the McMaster University medical school in Ontario, Canada.

Sub-groups of the studies included in the analysis suggest that non-opioid options – such as NSAIDs, antidepressants and medical cannabis – can offer average-like opioid benefits. But the evidence about that is less strong, says Busse.

The analysis comes as federal agencies and other officials in recent years have been catching down on the prescription of opioids, which is double recognized as an important tool in treating pain and as a gateway to physical dependence and captivity.

In 2016, the USA Centers for Disease Control and Prevention issued guidance that encourages doctors to prescribe these drugs more responsibly to people with chronic pain. But Busse said that the CDC report laying down the bar for placebo-controlled studies was too high in its analysis; He looked for studies followed by patients for at least one year, and none of them.

"We have looked at many additional evidence that has not been considered by the CDC guides," he said.

Dr. Jianguo Cheng, president of the Academy of American Pain Medicine, said the new analysis reinforces what constitutes conventional wisdom among pain experts. It was not part of the study.

"We're going to try the least dangerous drug first, so it's opioids [are] not the first line of treatment in most cases, "said Cheng, also director of the director of the Cleveland Clinical Multidisciplinary Pain Medicine Fellowship Program." It is not a second treatment, and may not be a third line of treatment. "

The CDC describes chronic pain such as "for more than 3 months or after the normal tissue healing." Amongst the main reasons for seeking medical care in the US, which affect just over 20% of adults – about 50 million people – in 2016, according to one report this year. Other estimates suggest that the number is double.

"There is a very complex and diverse population of patients," said Cheng, including those who may have suffered injuries, had multiple surgeries or living with a disability.

This is different from other types of pain, such as acute pain and cancer pain. For the latter, Cheng said, the use of opioids is much less controversial.

As most of these patients will not see meaningful improvements, however, do not ignore the sub-set that will prove them, says Busse.

"Problem interpretation of [the study findings] It would be: Opioids do not provide any meaningful pain binding, "he said." The challenge with that interpretation is to assume that every patient will have the same pain relief. "

Opioid history: O & # 39; a drug of wonder & # 39; to epidemic abuse

His study estimates the amount of chronic pain patients that a doctor would need to treat in order for one to have meaningful improvements: For pain, there are around eight patients. For exercise, there are 12 patients. For sleeping quality, 17 patients.

And here's the "best case scenario," according to editorial published in the same journal by doctors with the Pennsylvania University Anesthesia and Critical Care Department.

The studies included in the analysis mainly put pressure on patients with past or present substance disorders, which Busse described as "the choice of patients who would be better ahead". Almost half of the studies also excluded patients who were diagnosed or treated for mental illness.

More than three-quarters of the studies were funded in the analysis by the pharmaceutical industry, identifying the study. Other research has shown that industry-funded studies tend to produce better results across a variety of areas.
In recent years, pharmaceutical companies have become under fire for opiate marketing opioids for doctors. As a result of the early 2000s, opioids were seen as a drug of wonder, and doctors were encouraged to treat more aggressive pain. Former Superintendent Vivek Murthy wrote in an open letter that doctors learned that these medicines were not addictive if patients were in "legal pain." Multiple studies have shown that this is fake.
The 2013 study estimated that one in five patients who see a doctor for the pain of chronic disorders or chronic disorders have prescribed opioids.
Another study last year supported the CDC and other health specialists to remove chronic pain patients from opioids when possible, saying they could have a better quality of life without them. But Cheng says that this should be done carefully and may not be working immediately for all patients, adding, "I've seen many patients left by their doctors, and they can not find & # 39; The people control their pain. "

According to Cheng, alternative treatments that may be effective – such as physical and cognitive behavioral therapies – may be out of reach to many patients, in some cases because insurance does not repay these services.

However, despite gaps in information about chronic pain treatment, experts say that opioids are part of that array – even if they bring better risks and benefits.

"For individuals who suffer from incredible chronic pain daily from their lives, if they have tried other options that have not worked, they may in some cases decide that they are still want to start a test of [opioid] Therapy, "says Busse," and now they have the evidence to understand their chances of achieving meaningful improvement. "

Nadi Kounang contributed CNN to this report.

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