Choosing an Opioid – Our Best Buy Pick (Consumer Reports)

Choosing an Opioid – Our Best Buy Pick (Consumer Reports)

Unfortunately, the research comparing opioids to each other in the treatment of people who have chronic pain is quite limited. That means that, in terms of effectiveness, one opioid may be better than another – either overall or in treating certain types of pain or certain people – but the medical evidence just does not exist to prove it.

That said, the evidence that does exist suggests strongly that when comparable doses of any of the opioids are used, the relief from pain is about the same. Opioids also seem to produce similar results when quality of life is the main outcome measured.

Thus, there is not enough evidence from the research to say that one opioid is more effective or better than any other in treating people who have chronic pain.

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When an NSAID May Be Better

When an NSAID May Be Better

If your mild chronic pain is not sufficiently controlled by acetaminophen, or involves inflammation (see the box on section 3), talk with your doctor about trying an NSAID. For reasons still unclear, some people respond better to one NSAID over another. There’s no way to know besides trying them out. We advise starting with naproxen (Aleve and generic) or ibuprofen (Advil, Motrin, and generic).

Both of these drugs have anti-inflammatory effects, are inexpensive, and are available without a prescription (though higher dose pills require a prescription). Aspirin is not the best choice in treating chronic pain since the larger doses typically needed for pain relief and easing inflammation may pose a higher risk of stomach bleeding and upset compared to naproxen, ibuprofen, or other NSAIDs.

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What Are Opioids and Who Needs Them?

What Are Opioids and Who Needs Them?

Opioids work by changing the way pain is experienced and “felt.” They literally block pain signals to and in the brain. They also have sedative effects which can improve rest and sleep.
If you have been diagnosed with chronic pain, you have several treatment options. Your first decision is whether to take any pain medicines at all. That decision almost always revolves around how severe your pain is, and whether you are able to work and live fairly normally with the pain. Since pain is an entirely subjective experience, only you and your doctor can reach this decision.

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Opiates Raise Atrial Fibrillation Risk; AFib Makes Heart Attacks More Likely

Opiates Raise Atrial Fibrillation Risk; AFib Makes Heart Attacks More Likely

Researchers say using opioids such as hydrocodone can increase your risk of developing an irregular heartbeat, and an irregular heartbeat can make you more likely to have the most common kind of heart attack.
If you have atrial fibrillation, your risk of suffering the most common type of heart attack goes up.

And if you take an opioid such as hydrocodone, you’re increasing your risk of developing an irregular heartbeat in the first place.

That’s the conclusion of two new studies released today.

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Doctor Defends Use of Urine Drug Tests

Doctor Defends Use of Urine Drug Tests

A prominent pain doctor is disputing reports that a widely used urine drug test often gives faulty results.

“They are reasonably reliable and highly cost effective for use in a pain management practice. I would strongly recommend the practitioners use this,” said Laxmaiah Manchikanti, MD, chairman and CEO of the American Society of Interventional Pain Physicians.
Dr. Manchikanti, who is medical director of a pain clinic in Paducah, Kentucky, was the lead author of a study published in the journal Pain Physician in 2011, which looked at the reliability of immunoassay “point-of-care” (POC) tests. The urine tests are inexpensive and give immediate results, and doctors often use them to monitor their patients for opioid or illicit drug use.

“The UDT (urine drug test) with immunoassay in an office setting is appropriate, convenient and cost effective. Compared with laboratory testing for opioids and illicit drugs, immunoassay office testing had high specificity and agreement,” Manchikanti’s study found.
Pain News Network recently reported on the results of a second study conducted by Millennium Health, a San Diego-based drug testing laboratory, which found that POC tests were wrong about half the time – frequently giving false positive and false negatives results for drugs like marijuana and oxycodone. The Millennium study advocates the use of chromatography-mass-spectrometry – a more complex laboratory test that costs thousands of dollars – to confirm POC test results.
“Following the advice from companies in reference to numerous expensive tests and also income generating avenues will only lead to time in the slammer and will not improve patient care at all,” said Manchikanti.

“(The) Millennium study is performed by the company which makes a living by testing. The more samples that are sent to them, the better off they are. Further, they are not even a practical setting. From our practice we send approximately only 2% of the samples for confirmation testing. Even then, the patients can’t pay their bills.”

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Living with Pain: Is the War on Pain Patients a Human Rights Violation?

Living with Pain: Is the War on Pain Patients a Human Rights Violation?

When we read about human rights violations, we usually think of Russia, China or third world countries. We rarely think of the United States. Yet here in the U.S. we are involved in a war on chronic pain patients that is especially egregious in Washington state and Florida.

This war on pain patients is waged by the Drug Enforcement Administration, federal and state prosecutors, politicians and government agencies. Their efforts are bolstered by special interest groups, which have joined with legislators in their unbalanced efforts to reduce the amounts of available opioid analgesics and to limit the number of people who have access to these powerful pain relievers.
The rationale for this war is that over the past decade there has been quite an increase in opioid analgesic prescribing, which authorities blame for the growing problem of diversion, addiction, accidental overdose and death. The thinking is that if prescriptions are limited, then the associated problems with these medicines will be ameliorated.

The special interest groups point to a few research reports indicating that a large portion of patients taking these medicines become addicted. But the available research on this is spotty and not yet well developed to make any conclusions.

Since the passage of legislation in Washington, pain patients have been dropped by their physicians and denied opioid prescriptions by cowed pharmacies worried about being closed by the DEA. Physicians who previously treated people with intractable pain are turning away patients as they fear scrutiny and the possible loss of their licenses to practice.

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Type of Chronic Pain May Affect Risk for Suicide

Type of Chronic Pain May Affect Risk for Suicide

Suicide is the 10th most common cause of death in the United States, and is often related to serious depression, alcohol or substance abuse, or a major stressful event. Given the high correlation between chronic illness and depression, it is not surprising that studies have found suicidal ideation, suicide attempts and suicide completions to be common in patients with chronic noncancer pain. Now, researchers believe that the type of chronic pain also may play a role in risk for suicide.

“About 20% [of patients with chronic pain] most likely have passing suicidal thoughts; 5% have active thoughts; and about 5% have a past history,” said Martin Cheatle, PhD, director of the Pain and Chemical Dependency Program at the University of Pennsylvania, Philadelphia. “So, it is a pretty significant problem.”

Recent research has now expanded its scope to determine what chronic pain conditions are most closely linked to suicide risk. A study conducted in Spain found that suicidal ideation is highly prevalent among patients with severe fibromyalgia, a disorder that is characterized by chronic pain, sleep disturbances and depression (Pain Pract 2014 Jan 17. [Epub ahead of print]). Of 373 patients with fibromyalgia, 179 (48%) reported suicidal ideation. Of those, 148 (39.7%) described what was considered to be passive suicidal ideation and 31 (8.3%) reported active suicidal ideation. Risk for suicide was more commonly related to symptoms of psychological distress (depression, anxiety, sleep quality, mental health) than to physical symptoms of the disease (pain, general health).

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