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> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. As you've already

> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. As you've already asserted in your other comments here and I've asked elsewhere, could you expand on this assertion?

DanBC 8y ago
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain. > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation) > 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit. > 4. If a patient is using opioids but is still in pain, the opioids are not effective and should be discontinued, even if no other treatment is available. > 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detail assessment of the many emotional influences on their pain is essential. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/challenges-of-long-term-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and, if unresolved, can act as a barrier to treatment. The assessment of chronic pain needs to be wide-ranging and comprehensive. The persistence of symptoms is particularly relevant in relation to prescribing where patients may be exposed to cumulative harms of drugs over prolonged periods. If a patient continues to have pain despite taking a number of medications, drugs should be sequentially tapered or stopped to establish continued utility. Similarly, if a patient reports reasonable pain relief from a medication regimen in the longer term, it is also necessary to taper medications intermittently to assess whether the symptoms have resolved spontaneously or whether the patient is relatively pain free because of continued efficacy of medication. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/role-of-medicines-in-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > Medicines are generally less effective for persistent pain than for other types of pain. When medicines are prescribed they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning.
- justinjlynn 8y ago
  Well, that's a far more nuanced argument than yours. Frankly, you'd be better off quoting that than making veridical statements such as 'does not' when your own evidence indicates it 'sometimes' does. Certainly opioids are not a front line treatment, and never were, but I would avoid going around saying they 'do not work' when clearly sometimes they do and it's a highly contextual decision. You may want to say instead that there is little evidence supporting their widespread use in long term pain management as a primary strategy. That would be supported by what you've posted and I'd take no issue with that statement.
  - DanBC 8y ago
    The problem is that opioids are a front line treatment, and are being prescribed by GPs and not only hospitals or pain clinics. Opioid sales quadrupled in the US between 1999 and 2014, and a lot of those were family doctors.
mmt 8y ago
I'm pretty sure this is generally accepted to be true in the medical/scientific community (and I suspect isn't new, considering how long opium and its derivatives have been in use). Using "opioid long term pain" or "opioid chronic pain" as search terms for Google or Google Scholar should bring up plenty of reviews and meta-studies that elaborate on this concept.

DanBC 8y ago

https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain. > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation) > 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit. > 4. If a patient is using opioids but is still in pain, the opioids are not effective and should be discontinued, even if no other treatment is available. > 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detail assessment of the many emotional influences on their pain is essential. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/challenges-of-long-term-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and, if unresolved, can act as a barrier to treatment. The assessment of chronic pain needs to be wide-ranging and comprehensive. The persistence of symptoms is particularly relevant in relation to prescribing where patients may be exposed to cumulative harms of drugs over prolonged periods. If a patient continues to have pain despite taking a number of medications, drugs should be sequentially tapered or stopped to establish continued utility. Similarly, if a patient reports reasonable pain relief from a medication regimen in the longer term, it is also necessary to taper medications intermittently to assess whether the symptoms have resolved spontaneously or whether the patient is relatively pain free because of continued efficacy of medication. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/role-of-medicines-in-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > Medicines are generally less effective for persistent pain than for other types of pain. When medicines are prescribed they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning.

justinjlynn 8y ago
Well, that's a far more nuanced argument than yours. Frankly, you'd be better off quoting that than making veridical statements such as 'does not' when your own evidence indicates it 'sometimes' does. Certainly opioids are not a front line treatment, and never were, but I would avoid going around saying they 'do not work' when clearly sometimes they do and it's a highly contextual decision. You may want to say instead that there is little evidence supporting their widespread use in long term pain management as a primary strategy. That would be supported by what you've posted and I'd take no issue with that statement.
- DanBC 8y ago
  The problem is that opioids are a front line treatment, and are being prescribed by GPs and not only hospitals or pain clinics. Opioid sales quadrupled in the US between 1999 and 2014, and a lot of those were family doctors.

mmt 8y ago

I'm pretty sure this is generally accepted to be true in the medical/scientific community (and I suspect isn't new, considering how long opium and its derivatives have been in use). Using "opioid long term pain" or "opioid chronic pain" as search terms for Google or Google Scholar should bring up plenty of reviews and meta-studies that elaborate on this concept.