Wednesday, May 21, 2008

Benefits versus risks of taking Opioids

I wish every Doctor and the DEA would read articles like the one below. I was reading a news story last night about a DEA agent that was injured while on a raid. Now he is on a morphine pump and he talked about the difficulty in trying to get a doctor to treat him. We are all at risk here folks. It can happen to anyone. That's why it is so necessary for there to be more education about opioids and why they will stop severe pain when nothing else will. There is really a lot of research going on in this area. I just hope it doesn't fall on deaf ears.

As controversy swirls about proper clinical use of opioids and other potent pain medications, research reported at the American Pain Society annual meeting shows that, contrary to widespread beliefs, less than 3 percent of patients with no history of drug abuse who are prescribed opioids for chronic pain will show signs of possible drug abuse or dependence. In his plenary session address, Srinivasa Raja, MD, professor of anesthesiology, Johns Hopkins University Medical School, urged clinicians and policy makers not to allow the small percentage of abused pain prescriptions to prevent legitimate pain patients from getting the care they need.

"Physicians today face a dilemma in trying to balance the needs of their patients with demands from society for better control of opioid medications. We also are dealing with unfounded accusations in the media that increased prescribing of opioids for severe chronic pain is responsible in large part for reported upswings in the abuse of pain medications," said Raja. "We do need stronger evidence about which patients will benefit most from these medications to help make better prescribing decisions," he added. "But for most chronic pain patients, drugs are not the sole solution. More and more studies are showing that multi-faceted treatment involving physical and cognitive-behavioral therapies and appropriate interventional strategies lead to the most favorable outcomes." According to Raja, the problem of prescription drug abuse can best be attacked and hopefully solved through collaborations involving care givers, regulatory and law enforcement agencies and the pharmaceutical industry.

"First, I believe physicians should be diligent is communicating with their patients about the benefits and risks of opioids and also screen them for drug-seeking behavior and other warning signs of potential abuse," said Raja. "Also, we must monitor patients carefully to determine when doses can be lowered over time as they improve their pain control and overall functioning." The message for law enforcement and federal and state regulatory agencies, first and foremost, is to strive for state-to-state consistency in regulating controlled substances and crack down on illegal internet pharmacies and prescription thefts and forgeries. "Progress is being made as there is increased awareness of the source of prescription opioids being diverted into the illicit market," said Raja, "and states and municipalities are stepping up their teen drug awareness education programs."

For pharmaceutical manufacturers, Raja said the key challenge is to match clinical needs for less addicting pain medication with drug development priorities. "There are novel analgesic formulations in various stages of development that we hope can be prioritized and expedited for clinical use," he said. Raja noted that fifty years ago, a commentary published in the Journal of the American Medical Association recommended that opioids should be avoided in treating cancer pain because of possible addiction, and 20 years ago it was believed infants didn't feel pain and shouldn't receive anesthesia. "We abandoned such faulty beliefs as scientific evidence proved otherwise," he said. "Now I hope history repeats itself in changing professional and public attitudes as we now know opioids are effective for treating chronic non-cancer pain and that very few legitimate pain patients abuse their medications.

Hopefully, the evidence will foster a middle-ground approach that protects the rights of patients and clinicians while upholding society's right to control medication abuse and diversion."

Thursday, May 8, 2008

Opioid use and sexual dysnfunction

I Came across this article that some of you may be interested in. I'll have to say that if you are in the kind of pain that I'm in, sex is the least of your worries. It does go to show you the amount of research that is going on but until the public, the medical profession and the Justice Department takes a different attitude about the millions of people that are suffering, and educate themselves on the use of opioids, I can't see where the great research being done is going to help. It is so sad that millions of people like me have to suffer so much because of the ego and stupidity of a few. It is happening though, every single day.

"Unfortunately, chronic pain and sexual problems often go together. Yet, many patients suffer in silence, healthcare providers rarely ask about patients’ sexual concerns, and guidance literature on the subject is relatively scarce. Ironically, the long-acting opioid medications prescribed to relieve patients’ pains often are the source of sexual dysfunction.

In an evidence-based commentary article for Pain Treatment Topics – “Opioid-Induced Sexual Dysfunction: Causes, Diagnosis, & Treatment” – Stephen Colameco, MD, MEd, discusses the problem and how healthcare providers can help their patients.
Considerable evidence suggests that long-acting opioids used on a daily basis for more than a month can reduce hormonal function in both men and women. Besides sexual dysfunction, symptoms can include weight gain, fatigue, depression, osteoporosis, and irregular menstrual cycles.

These problems can be treated, if they are properly diagnosed, but different approaches are needed in males and females. Colameco provides a number of recommendations:
-- Prior to the initiation of therapy, prescribers should inform patients that hormonal disturbances are common with higher dose, long-term opioid treatment.
-- After treatment is started, patients should be routinely evaluated for signs and symptoms of hormone deficiency, including sexual dysfunction.
-- When hormonal deficiency is suspected, appropriate laboratory testing should be ordered.
-- An important treatment in men often is testosterone supplementation. Topical, buccal, or transdermal formulations are preferred over intramuscular injections.
-- In women, testosterone treatment is controversial and supplementation with DHEA/DHEAS may be preferred due to its ability to raise hormone levels without significant side effects. Alternatively, rotation from one opioid medication to another may be effective.

In sum, opioid treatment is intended to reduce patients’ pain, and to improve physical and social functioning. Opioid-induced hormonal deficiencies and associated sexual dysfunctions are common and often overlooked consequences of opioid therapy. If left untreated, they may negate the potential benefits of this analgesic. It is hoped that through a better understanding of these problems opioid therapy can be more effectively used in the treatment of chronic pain.
The complete article (8 pages) is available for free access at: ".