Saturday, June 23, 2012

Opioids can make pain worse

Here is an interesting article on pain management.
Opioidsdrugs like oxycodone and hydrocodonehave extremely effective analgesic or pain-relieving properties. These medications were once used primarily to treat cancer pain or acute (short-term) pain, such as from injury or surgery. Then in 1995, pain advocacy groups—organizations that receive funding from drug companies—began to issue statements and policies endorsing the use of opioids to treat chronic pain, and downplaying risks such as side effects, dependence, risk of overdose, and addiction. Pharmaceutical companies have since spent (and made) billions marketing and promoting these drugs to healthcare providers and directly to consumers. These efforts to expand the market for opioid painkillers have been very successful in terms of financial gain for drug companies, but not for quality of care or improvement in patients’ lives.


I've been visiting the Pain Clinic in Ottawa with a client. Her pain was not being managed well, as she has complex care requirements.

What is interesting is that for some who develop a tolerance to opioids, they may be on the wrong pain medication in the first place.
My friend, Michele with Spinal Stenosis, has excrutiating pain 24/7, and has been on morphine pills for many years. She is finding that the doses are not sufficient. She needs a pain specialist, and they are not making house calls in long-term care.

For one thing, there is a tolerance that develops. In some cases, the patient can develop Opioid-Induced Hyperalgesia Syndrome.
Opioid-Induced Hyperalgesia Syndrome A heightened sensitivity to pain can be caused by the very medications used to treat chronic pain. Opioid pain medications.


What the Doctor, an anesthesiologist, told me and my client, is that hydromorphone is not in the Canadian standard recommendations for Neuropathic Pain. The destruction of the nerves in some  is similar to cancer pain. Hydromorphone in the body prevents the uptake of cell information about pain messages.  However, eventually, the Hydromorphone goes around the back door of the cell, and adds receptors, which tell the patient s/he is in pain. This is pain tolerance, in many patients.
 Each tablet for oral administration contains 8 mg Hydromorphone hydrochloride. In addition, the tablets contain the following inactive ingredients: lactose anhydrous, magnesium stearate, microcrystalline cellulose and silicon dioxide.

Methadone is a drug that works well for neuropathic pain. Yet, myths abound. There are fears, but this is a drug that provides pain relief.

www.ncbi.nlm.nih.gov/pmc/articles/PMC2670721
Pharmacological management of chronic neuropathic pain – Consensus statement and guidelines from the Canadian Pain Society
FIRST-LINE ANALGESICS:
 Tricyclic antidepressants, Anticonvulsants
 SECOND-LINE ANALGESICS:
Serotonin noradrenaline reuptake inhibitors, Topical lidocaine
 THIRD-LINE ANALGESICS:
Tramadol, Opioid analgesics.
FOURTH-LINE ANALGESICS:
Cannabinoids, Methadone, Selective serotonin reuptake inhibitors (SSRI), Other anticonvulsants.
 ~~~~~~~~~~~~~
Opioids, also known as narcotics, are a class of medications used to control pain. They are the most effective pain medications. Examples of frequently used drugs are oxycodone, morphine, codeine and fentanyl. As a class, opiods have a high potential for dependence and addiction. 


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