Jon Newman
08-08-2007, 08:15 PM
I recently read this interesting commentary by Nathaniel Katz in The Clinical Journal of Pain
Here's the reference:
Clin J Pain. 2007 May;23(4):303-6. Links
Opioids: after thousands of years, still getting to know you.
Katz N.
Analgesic Research, Needham, MA 02494, USA. nkatz@analgesicresearch.com
PMID: 17449990 He begins:
The use of opioids for chronic pain has been evident throughout the millenia of recorded history, even while opinions about the use of opioids for chronic pain have fluctuated, like a pendulum, from one extreme to the another. The preserved remains of cultivated poppy seeds and pods have been discovered in sites of Neolithic dwellings in Switzerland, dating from the fourth millennium BC. The first human writing, from Sumeria around 2400 BC, used ideograms representing the poppy, translated as the "joy plant."He points out that
Prescription opioid abuse is the second largest type of illicit drug abuse, second only to marijuana, and ahead of cocaine and heroin. New initiates to illicit drug use now report prescription opioids as the first drug they try (2.1 million in 2005), ahead of marijuana, and nearly equal to the number of new inititates to smoking (2.3 million). Deaths related to prescription opioids continue to rise year after year at an alarming rate. About one in ten 12th graders has tried a prescription opioid nonmedically. Of the approximately 1.3 million suicide attempts per year by adolenscents, about one-half involve pain relievers.But this is the paragraph that hooked me
Why has the opinion of the world's leading experts on opioid therapy fluctuated so dramatically from century to century for thousands of years without any sign of settling into an evidence-based consensus? One likely cause is the absence of systematically acquired and soberly interpreted data on the important questions relevant to long-term opioid therapy. Without the anchor of data, experts are free to opine based on the vagaries of their prersonal experience. One would think that in this era of evidence-based medicine, one could simply turn to the clinical research literature on opioids and find answers to the most pressing questions about long-term opioid therpary. After all, pain is the most common complaint leading a patient to a physician. Including lost work productivity, pain may be the most costliest disease in the United States. Opioids are the most common medications prescribed by doctors in the United States.And finally, this "say what?" fact
Remarkably, the first RPCT of opioids for chronic pain did not appear until the mid 1990's, and the entirety of this body of RPCT literature appeared as if by magic in less than a decade.RPCT means "randomized placebo controlled trial"
While I find myself pondering numerous things the two that I'll encourage some conversation about here are:
1. Is it helpful to consider pain as a disease as mentioned by the author? I'm not sure if this stood out to anyone as they read it but it did to me.
2. Second are the author's comments about...well let me restate them
One likely cause is the absence of systematically acquired and soberly interpreted data on the important questions relevant to long-term opioid therapy.How does one go about soberly interpreting data? I'm assuming one doesn't literally have to be sober at the time.
Oh, the important questions raised by the author include:
Are opioids efficacious for chronic pain?How effective are opioids in the long run?What proportion of patients prescribed opioids become addicted? Can they be identified early before problems get out of hand?Is opioid prescribing a driver of prescription opioid abuse, or can be rest assured that our patients rarely develop abuse-related problems?What proportion of patients develop tolerance, so that the medication loses its usefulness over time? Do side effects get better over time?
Here's the reference:
Clin J Pain. 2007 May;23(4):303-6. Links
Opioids: after thousands of years, still getting to know you.
Katz N.
Analgesic Research, Needham, MA 02494, USA. nkatz@analgesicresearch.com
PMID: 17449990 He begins:
The use of opioids for chronic pain has been evident throughout the millenia of recorded history, even while opinions about the use of opioids for chronic pain have fluctuated, like a pendulum, from one extreme to the another. The preserved remains of cultivated poppy seeds and pods have been discovered in sites of Neolithic dwellings in Switzerland, dating from the fourth millennium BC. The first human writing, from Sumeria around 2400 BC, used ideograms representing the poppy, translated as the "joy plant."He points out that
Prescription opioid abuse is the second largest type of illicit drug abuse, second only to marijuana, and ahead of cocaine and heroin. New initiates to illicit drug use now report prescription opioids as the first drug they try (2.1 million in 2005), ahead of marijuana, and nearly equal to the number of new inititates to smoking (2.3 million). Deaths related to prescription opioids continue to rise year after year at an alarming rate. About one in ten 12th graders has tried a prescription opioid nonmedically. Of the approximately 1.3 million suicide attempts per year by adolenscents, about one-half involve pain relievers.But this is the paragraph that hooked me
Why has the opinion of the world's leading experts on opioid therapy fluctuated so dramatically from century to century for thousands of years without any sign of settling into an evidence-based consensus? One likely cause is the absence of systematically acquired and soberly interpreted data on the important questions relevant to long-term opioid therapy. Without the anchor of data, experts are free to opine based on the vagaries of their prersonal experience. One would think that in this era of evidence-based medicine, one could simply turn to the clinical research literature on opioids and find answers to the most pressing questions about long-term opioid therpary. After all, pain is the most common complaint leading a patient to a physician. Including lost work productivity, pain may be the most costliest disease in the United States. Opioids are the most common medications prescribed by doctors in the United States.And finally, this "say what?" fact
Remarkably, the first RPCT of opioids for chronic pain did not appear until the mid 1990's, and the entirety of this body of RPCT literature appeared as if by magic in less than a decade.RPCT means "randomized placebo controlled trial"
While I find myself pondering numerous things the two that I'll encourage some conversation about here are:
1. Is it helpful to consider pain as a disease as mentioned by the author? I'm not sure if this stood out to anyone as they read it but it did to me.
2. Second are the author's comments about...well let me restate them
One likely cause is the absence of systematically acquired and soberly interpreted data on the important questions relevant to long-term opioid therapy.How does one go about soberly interpreting data? I'm assuming one doesn't literally have to be sober at the time.
Oh, the important questions raised by the author include:
Are opioids efficacious for chronic pain?How effective are opioids in the long run?What proportion of patients prescribed opioids become addicted? Can they be identified early before problems get out of hand?Is opioid prescribing a driver of prescription opioid abuse, or can be rest assured that our patients rarely develop abuse-related problems?What proportion of patients develop tolerance, so that the medication loses its usefulness over time? Do side effects get better over time?