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Do the Benefits of Opioid Pain Relievers Outweigh the Risks for the Treatment of Chronic, Non-Cancer Pain?

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The risks associated with opioid pain relievers outweigh the benefits for patients suffering from chronic pain, according to a new policy statement from the American Academy of Neurology. The position paper says that the risk for death, overdose, serious side effects including addiction associated with this class of prescription drugs outweigh the benefits when used in the treatment of chronic, non-cancer conditions such as fibromyalgia, headache, and chronic low back pain.
Drug manufacturers create opioid drugs from morphine, codeine, and other extracts of the opium poppy plan. Doctors routinely prescribe opioid drugs to relieve pain and calm anxiety. Opioid drugs are a class of medications that include oxycodone, methadone, fentanyl, and hydrocodone.
Published in the September 30, 2014, print issue of Neurology®, the medical journal of the American Academy of Neurology (AAN), the paper outlines several ways the risks of using opioid drugs outweigh the benefits of use, including death and addiction.
More than 100,000 people have died in the United States since the 1990s, before policies restricting use of these drugs became more liberal. In fact, there have been more deaths from opioids in young to middle-aged adults than from guns or car accidents.
Scientific studies show that half of all patients taking opioids for at least three months are still taking them five years later. While research shows that opioids are effective for short-term pain, there is no evidence that these drugs relieve pain or improve function over a long period without significantly increasing the consumer’s risk for overdose, physical dependence or addiction.
There is little scientific evidence that using opioids longer than 16 weeks has any effect on pain but there is a mountain of research that shows using opioids for four months or longer significantly increases the risk for side effects, especially addiction, physical dependence, overdose, and death. In an interview with MedPage Today, the sole author of the statement, Gary Franklin, MD, of the University of Washington in Seattle said, “The evidence of harm is high, and the effectiveness is low.”
Restoring the Balance of Benefits and Risks
The position paper outlines best practices for prescribing opioid pain relievers to patients with cancer. The AAN recommends the physician consult with a pain management specialist when prescribing dosages of an opioid greater than the equivalent of 80 to 120 mg of morphine per day, especially when opioids do not seem to be improving pain or function.
Physicians should screen for past drug abuse, screen for depression, and avoid prescribing benzodiazepine products to patients on opioids as combining these two drugs increase the risk for overdose. The paper also recommends physicians enter an opioid treatment agreement with patients and perform random drug screenings to ensure patients remain compliant with that agreement.
Quitting opioids is not always easy, especially for people who have used these drugs for a long time. Continuous opioid use greatly increases the risk for developing physical dependence resulting in uncomfortable, flulike withdrawal symptoms when the individual stops using opioids. Stopping opioid use also causes pain to return, making it doubly hard to quit opioids. Individuals facing this difficult situation benefit from medical detoxification that makes the withdrawal process easier to endure.
The physicians, doctors, therapists and staff at WAISMANN METHOD® work with patients to create personalized treatment and aftercare plans designed to ensure a healthy and effective transition to other pain management techniques to treat chronic pain unrelated to cancer.

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