A few years ago, codeine was removed from otc pain products, which I thought at the time was a bit stupid. The rationale I got from the pharmacist was something like stopping addicts from going around buying up lots of panadeine. Really?
Even though I only used it occasionally to overcome short-term pain issues and never once felt 'hooked' on it, I suspected there was some other agenda involved. Thanks for clearing that up.
Yes, there definately WAS an agenda. Addiction and overdose rates are unchanged, and people in pain can't safe, effective codeine anymore. It was never about people using opioids for pain.
Really excellent commentary Neen. As you note, biased and even fraudulent studies have been used by anti-opioid zealots to hobble prescribing and cause untold suffering and even death. Taken as an extreme, it’s even led to people being denied pain relief after major surgery, even on their death bed with intense suffering, and also denied to animals after surgery. What people also need to know, apart from the fact that opioids can work very well and are not necessarily addictive at all, is that for non-cancer chronic pain that doesn’t have sufficient explanatory pathology, opioids are *generally* not better than paracetamol, which in turn is not very effective at all. Furthermore, there’s some evidence that opioids can make the person more sensitive to pain signals, at the same time decreasing in effect. The most important point out of all of this is that we have to be led by the patient because that’s the humane thing to do. If the patient reports that opioids decrease their pain and increase their quality of life, we have to believe them. If tapering is done it must and should be 100% voluntary (zero pressure or coercion) and with a guarantee that there will be no increase in pain or the dosage will be set higher. Pain sufferers are not addicts and opioids save lives.
Yes, yes, yes, agree with everything you say. Can you run for parliament??? we'll elect you :)
I'm looking into a lot of the controversies surrounding opioids, opioid induced hyperalgesia is one of the major ones. Initial research implies that its a rare phenomenon, but its being used as an excuse to taper many people. So much misinformation and disinformation...and people suffer!
What you say about chronic pain without explanatory pathology is very important too, opioids are definatley the wrong approach for primary pain. Which is why understanding the distinction and differences between primary and secondary pain is so essential in my opinion. But very few people do.
Its really very simple. But GPs don't have time, and its much easier to just refuse to prescribe. And force taper. I know far too many people who have been force tapered, and its barbaric!
Lol Neen :-) The forced taper is one of the most barbaric things we can do to people, almost as bad as flat out refusing pain relief to animals and people after major surgery, or who are actually dying in agony. It’s difficult if not impossible to determine what is the cause of many people’s chronic pain. If they say that opioids are effective for them and allow them to function and have better quality of life, we have to believe them. In addition there are protocols available to doctors to determine whether hyperalgesia or tolerance is at play. It shouldn’t be a guess, but unfortunately it seems it often is.
Yes, its a guess, and they're told the solution is to taper (for hyperalgesia). A bit of common sense says that if its hyperalgesia, lower the dose. If pain gets better, you're right. Its OIH. BUT if pain gets worse, you're WRONG! its not hyperalgesia, its disease progression, or tolerance. ANd the dose should be reinstated, and the person should be reassessed.
But they don't do that. Patient complains? TAPER!
Honestly, I try to put myself in GPs shoes, and I try to remind myself how hard it is to be a GP. But force tapering people is truly barbaric. And as you say, if the person says, that opioids help, then give htem opioids! Opioids are very, very safe medicines. but you'd never know it.
co some rich white men in America dont like that idea. They want prohibition (can't wait until htey are old, and suffering from disease-related pain).
To make people taper opioids they had to build this entire wall of lies...opioids are not safe. opioids are not effective. BULLSHIT! And to discredit peopel they had to amplify the 'addiction' angle. Which is why were are all treated as addicts looking for a high...insead of people who are truly suffering, horrible, terrible, unbearable pain.
I'm sorry, but tonight my pain is at its worst. and I am not thinking straight. AndI am going to take an extra pill, becuase i honestly can't cope anymore. I have had enough. One day a month, I can sneak an extra pill. And one night a month, I get to sleep for six hours straight. unwoken by pain. Pain controlled. one night a month. but tell a doctor and they'll give me sleep hygiene advice. The pain is keeping me awake, fuckstick, its not me being awake causing pain! They have twisted this so, so far, and some pain patients are complicit. becuase they have milder pain, they have primary pain. they can make their pain go away by making better choices.
But I can't. I have a painful disease. or two.
How are we living in a world where doctors no longer can tell the difference between pathology and psychology???? its so simple. Not to dismiss psycholgoical pain, it is also terrible. it just requres different treatments that don't include opioids/
I'm sorry, I am rambling. AT the end of my rope. But I will not stop fighting. I will keep on working. its work. all of it. hard, hard work. This is barbarism, this is torture. this is inhuman.
But thankyou, you have done an incredible amount of work, and you have the credientials and you are doing so much for people like me. You have put the evidence out there, the science. thankyou for fighting for people who are suffering needlessly. no matter how strong a person is, constnat,severe, pain will undo everyone. its awful. its unecessary. And if i say I can't cope anymore...then Im mentally ill, and I have depression. its not pain, its never pain. its gaslighting. they have an answer to everything. sorry. I will breathe. I will lie her on my electric blanket, with my heated throw on top. With my beloved dogs next to me. And I will get through tonight. just like every other night where it all became too much, too hard, too much pain. sorry for rambling. Thankyou for fighting and working for people in pain. we need more people to rmember what pain really is...its not discomfort. I've woken up from ortho surgeries that hurt less than I do right now. three levels of my spine fused. the recovery was less painful than life before the fusion. I'll stop now. sorry.
Worth considering is Dr Avram Goldstein's 1985 paper presented to the Toronto International Addiction Conference. His finding is that the drug Morphine is made in the human adrenal glands, and is a hormone. All people are on this potent opioid from conception until death. Since everyone is always on this hormone, addiction is not linked to exposure or addiction would be normal behaviour. For details here's a summary and bibliography of Goldstein's initial finding and many hundreds of researchers who followed up on his lead. http://t.co/pzVCtYWkeu
The 1st time I was prescribing OxyContin was when I had my wisdom teeth removed. I had 3 tablets and didn’t touch them again, they went out of date I threw them out as I didn’t need them. Cut to 10 years later now I take them daily. Respectfully and controlled, to get through my days with secondary chronic pain.
Withdrawal from my prescription opiates was the worst experience I ever had. Mere words do not convey the physical, emotional, mental and spiritual anguish I endured for almost a whole year. Two months after my pain doctor relocated, ( no local provider would help me) I had a heart attack.
Thank you for being brave enough to share your plight.
A few years ago, codeine was removed from otc pain products, which I thought at the time was a bit stupid. The rationale I got from the pharmacist was something like stopping addicts from going around buying up lots of panadeine. Really?
Even though I only used it occasionally to overcome short-term pain issues and never once felt 'hooked' on it, I suspected there was some other agenda involved. Thanks for clearing that up.
Yes, there definately WAS an agenda. Addiction and overdose rates are unchanged, and people in pain can't safe, effective codeine anymore. It was never about people using opioids for pain.
Really excellent commentary Neen. As you note, biased and even fraudulent studies have been used by anti-opioid zealots to hobble prescribing and cause untold suffering and even death. Taken as an extreme, it’s even led to people being denied pain relief after major surgery, even on their death bed with intense suffering, and also denied to animals after surgery. What people also need to know, apart from the fact that opioids can work very well and are not necessarily addictive at all, is that for non-cancer chronic pain that doesn’t have sufficient explanatory pathology, opioids are *generally* not better than paracetamol, which in turn is not very effective at all. Furthermore, there’s some evidence that opioids can make the person more sensitive to pain signals, at the same time decreasing in effect. The most important point out of all of this is that we have to be led by the patient because that’s the humane thing to do. If the patient reports that opioids decrease their pain and increase their quality of life, we have to believe them. If tapering is done it must and should be 100% voluntary (zero pressure or coercion) and with a guarantee that there will be no increase in pain or the dosage will be set higher. Pain sufferers are not addicts and opioids save lives.
Yes, yes, yes, agree with everything you say. Can you run for parliament??? we'll elect you :)
I'm looking into a lot of the controversies surrounding opioids, opioid induced hyperalgesia is one of the major ones. Initial research implies that its a rare phenomenon, but its being used as an excuse to taper many people. So much misinformation and disinformation...and people suffer!
What you say about chronic pain without explanatory pathology is very important too, opioids are definatley the wrong approach for primary pain. Which is why understanding the distinction and differences between primary and secondary pain is so essential in my opinion. But very few people do.
Its really very simple. But GPs don't have time, and its much easier to just refuse to prescribe. And force taper. I know far too many people who have been force tapered, and its barbaric!
Lol Neen :-) The forced taper is one of the most barbaric things we can do to people, almost as bad as flat out refusing pain relief to animals and people after major surgery, or who are actually dying in agony. It’s difficult if not impossible to determine what is the cause of many people’s chronic pain. If they say that opioids are effective for them and allow them to function and have better quality of life, we have to believe them. In addition there are protocols available to doctors to determine whether hyperalgesia or tolerance is at play. It shouldn’t be a guess, but unfortunately it seems it often is.
Yes, its a guess, and they're told the solution is to taper (for hyperalgesia). A bit of common sense says that if its hyperalgesia, lower the dose. If pain gets better, you're right. Its OIH. BUT if pain gets worse, you're WRONG! its not hyperalgesia, its disease progression, or tolerance. ANd the dose should be reinstated, and the person should be reassessed.
But they don't do that. Patient complains? TAPER!
Honestly, I try to put myself in GPs shoes, and I try to remind myself how hard it is to be a GP. But force tapering people is truly barbaric. And as you say, if the person says, that opioids help, then give htem opioids! Opioids are very, very safe medicines. but you'd never know it.
co some rich white men in America dont like that idea. They want prohibition (can't wait until htey are old, and suffering from disease-related pain).
To make people taper opioids they had to build this entire wall of lies...opioids are not safe. opioids are not effective. BULLSHIT! And to discredit peopel they had to amplify the 'addiction' angle. Which is why were are all treated as addicts looking for a high...insead of people who are truly suffering, horrible, terrible, unbearable pain.
I'm sorry, but tonight my pain is at its worst. and I am not thinking straight. AndI am going to take an extra pill, becuase i honestly can't cope anymore. I have had enough. One day a month, I can sneak an extra pill. And one night a month, I get to sleep for six hours straight. unwoken by pain. Pain controlled. one night a month. but tell a doctor and they'll give me sleep hygiene advice. The pain is keeping me awake, fuckstick, its not me being awake causing pain! They have twisted this so, so far, and some pain patients are complicit. becuase they have milder pain, they have primary pain. they can make their pain go away by making better choices.
But I can't. I have a painful disease. or two.
How are we living in a world where doctors no longer can tell the difference between pathology and psychology???? its so simple. Not to dismiss psycholgoical pain, it is also terrible. it just requres different treatments that don't include opioids/
I'm sorry, I am rambling. AT the end of my rope. But I will not stop fighting. I will keep on working. its work. all of it. hard, hard work. This is barbarism, this is torture. this is inhuman.
But thankyou, you have done an incredible amount of work, and you have the credientials and you are doing so much for people like me. You have put the evidence out there, the science. thankyou for fighting for people who are suffering needlessly. no matter how strong a person is, constnat,severe, pain will undo everyone. its awful. its unecessary. And if i say I can't cope anymore...then Im mentally ill, and I have depression. its not pain, its never pain. its gaslighting. they have an answer to everything. sorry. I will breathe. I will lie her on my electric blanket, with my heated throw on top. With my beloved dogs next to me. And I will get through tonight. just like every other night where it all became too much, too hard, too much pain. sorry for rambling. Thankyou for fighting and working for people in pain. we need more people to rmember what pain really is...its not discomfort. I've woken up from ortho surgeries that hurt less than I do right now. three levels of my spine fused. the recovery was less painful than life before the fusion. I'll stop now. sorry.
Neen I’m so, so sorry. You are awesome.
Worth considering is Dr Avram Goldstein's 1985 paper presented to the Toronto International Addiction Conference. His finding is that the drug Morphine is made in the human adrenal glands, and is a hormone. All people are on this potent opioid from conception until death. Since everyone is always on this hormone, addiction is not linked to exposure or addiction would be normal behaviour. For details here's a summary and bibliography of Goldstein's initial finding and many hundreds of researchers who followed up on his lead. http://t.co/pzVCtYWkeu
The 1st time I was prescribing OxyContin was when I had my wisdom teeth removed. I had 3 tablets and didn’t touch them again, they went out of date I threw them out as I didn’t need them. Cut to 10 years later now I take them daily. Respectfully and controlled, to get through my days with secondary chronic pain.
Withdrawal from my prescription opiates was the worst experience I ever had. Mere words do not convey the physical, emotional, mental and spiritual anguish I endured for almost a whole year. Two months after my pain doctor relocated, ( no local provider would help me) I had a heart attack.
Thank you for being brave enough to share your plight.
I understand
https://www.facebook.com/groups/562417486383920/?ref=share&mibextid=NSMWBT
Sharing on Truth and Fakebook