CDC Slams Opioid Use for Chronic Pain in New Guidelines

My experience with opioid pain killers (Vicodin, oxycontin, etc.) and chronic pain

  • They've been very helpful

    Votes: 20 46.5%
  • They've been moderately helpful;

    Votes: 11 25.6%
  • They haven't had much effect

    Votes: 1 2.3%
  • They have been moderately harmful

    Votes: 2 4.7%
  • They've been very harmful

    Votes: 2 4.7%
  • I've found that other drugs work better at reducing my pain

    Votes: 7 16.3%
  • I do take drugs for pain but have never tried opioid pain killers

    Votes: 5 11.6%

  • Total voters
    43

Cort

Founder of Health Rising and Phoenix Rising
Staff member
The new CDC Guideline for Prescribing Opioids for Chronic Pain came down strongly against the use of opioids for chronic pain. If you're taking opioid pain killers such as such as Vicodin, hydrocodone and oxycontin expect things at the doctor's office to tighten up further. The report was squarely aimed at the primary care providers who prescribe most of these drugs.

The head of the CDC, Thomas Frieden stated that in most cases the risks of opioid use outweigh the benefits and that doctor's are largely to blame for what he called the "the prescription overdose epidemic"

"The prescription overdose epidemic is doctor-driven" Frieden said. Recognizing that primary care physicians simply don't feel confident in their ability to prescribe opioid pain drugs correctly, the CDC focused its guidelines on them. The guidelines apply to anyone experiencing chronic pain after more than three months.

Significant Health Concern

[fright]
bigstock-Pain-12250472.jpg
[/fright]The CDC reported that nearly two million Americans are either dependent on or are abusing prescription opioid pain relievers

The CDC estimates that 10 million Americans spend 9 billion dollars a year on opioid pain relievers, that about forty people die every day from prescription drug "abuse" - most of it unintentional, and that over 400,000 people visit emergency room because of prescription opioid drug overdoses.

"We know of no other medication routinely used for a nonfatal condition that kills patients so frequently," said CDC director Thomas Frieden. "We hope to see fewer deaths from opiates. That's the bottom line. These are really dangerous medications that carry the risk of addiction and death."

He said that many opiate pain-killers are as addictive as heroin and do little to control chronic pain.

The American College of Physicians largely agreed with the CDC effort stating that "many communities are being devastated by the adverse impact of opioid misuse." The problem is more complicated than taking too many painkillers. Patients who get hooked in opioid pain killers can go on to develop other dependencies.

The CDC did not state that opioids did not have some role in managing chronic pain. It's clear that opioids can cause many problems but surprisingly little study evidence addresses how effective opioids actually are at managing chronic pain.

Huge Research Hole

Given the size of the problem it's incredible, however, how little research has been done. The CDC acknowledged that few good studies have assessed how effective opioids actually are treating long term pain.
Few studies have been conducted to rigorously assess the long-term benefits of opioids for chronic pain (pain lasting >3 months) with outcomes examined at least 1 year later (14)
The report also acknowledged that their recommendations are not based on strong studies. An AHRQ report found most opioid studies to be of low quality.
In summary, evidence on long-term opioid therapy for chronic pain outside of end-of-life care remains limited, with insufficient evidence to determine long-term benefits versus no opioid therapy, though evidence suggests risk for serious harms that appears to be dose-dependent.
How insufficient is the evidence base? The CDC stated that not one study has compared the benefits and harms of long term opioid use to other pain treatment options.
"No study of opioid therapy versus placebo, no opioid therapy, or nonopioid therapy for chronic pain evaluated long-term (≥1 year) outcomes related to pain, function, or quality of life."
[fleft]
Drugs-cfs.jpg
[/fleft]The effects and benefits of long term opioid use is another major health issue that has mostly slipped between the cracks. It may be that the field has been ceded to the drug companies who have little incentive to fund studies that might show their products don't work very well long term. It's completely baffling sometimes how the NIH - tasked with improving the health of Americans - allocates its funding dollars.

Harms and Risks

Some trends, regarding harms, however, appear to be fairly clear:
  • Higher doses of prescription opioids in general are associated with a greater risk of overdose.
  • People taking high levels of opioids and getting them from several doctors are at increased risk of a fatal overdose
  • Epidemiological studies suggest that using benzodiazepines with opioids may increase the risk of overdose.
  • The risk of overdose is higher for patients with sleep apnea or other causes of sleep-disordered breathing, patients with renal or hepatic insufficiency, older adults, pregnant women, patients with depression or other mental health conditions, and patients with alcohol or other substance use disorders.
  • The long term use of opioid pain killers may lead to sleep apnea because of decreased respiratory drive.
  • Older adults may be at increased risk of bone fractures
  • Opioids taken during pregnancy increase the risk of several birth defects
Opioid pain-killers are perceived to be cheaper than other options but the CDC reports that acetaminophen, NSAIDs, tricyclic antidepressants, massage therapy, COX-2 inhibitors, SNRIs, anticonvulsants, topical analgesics, physical therapy, and CBT all have lower mean annual costs.

The report said nothing, however, about the effectiveness of these options vs opioids.

Twelve Recommendations

In a nutshell the CDC recommends that other means of pain relief be used for chronic pain. It recommended that
  • When opioids are used they should be combined with other therapies including other drugs and behavioral therapies.
  • Realistic goals for pain relief should be set before pursuing opioid therapy, the risks outlined and a plan for getting off opioids, if necessary, be put in place.
  • Immediate release (vs extended release) opioids should be used. The lowest effective dosage should be used.
  • Opioids should be used to manage acute pain for at most days.
  • Opioid effectiveness should be checked every few months.
  • Before getting opioids patients should take a urine test to see of they are already taking them
  • Doctors should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
  • Buprenorphine or methadone in combination with behavioral therapies should be prescribed for patients with opioid use disorder.
It's clear that much work remains to assess the benefits/risks of opioid pain-killer use, when it is effective and when it is not and what alternatives are available.

See the Full Recommendations here.
 
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Who Me?

Well-Known Member
I remember seeing something years ago about people in chronic pain not being able to get pain medication. And the one thing they said was that when people are in pain, they generally (my word) don't get addicted.

Obviously this is a bunch of suits who aren't in chronic pain so they don't know..

What behavioral therapies? Think you don't have pain so you won't? WTF?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I've been off my Tramadol and Bentyl (and all my MCAS meds) for 2 weeks now. Finding great relief with Malic Acid and supplements from Supreme Nutrition. I'm jazzed.

Issie
Congratulations!
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I remember seeing something years ago about people in chronic pain not being able to get pain medication. And the one thing they said was that when people are in pain, they generally (my word) don't get addicted.

Obviously this is a bunch of suits who aren't in chronic pain so they don't know..

What behavioral therapies? Think you don't have pain so you won't? WTF?
The people who are using these drugs properly are getting squeezed in the effort to stop overdoses and drug deaths. I was shocked at how little study has been done on the effectiveness of these drugs - particularly compared to other drugs - in chronic pain...
 

Lala

New Member
El tramadol no podía soportar, empecé a morir, vómitos, etc ..., muy mal, me enviaron con el dolor, y no me ha enviado tapentadol retard 25 mg, 2 al día, y aumentar gradualmente a necesitar cada semana a un límite de 200 mg. después de unos meses con 100 mg / día de junio mi médico me hizo pasar, pensé que era lo nuestro, un cansancio horrible, y apenas podía hablar, ni comer, ni sostenerner un vaso, o Tlfno, cuando fui al doctor, dijo él estaba con el estado de coma inducido por opioides después de la admisión, y la eliminación gradual de la misma (se puede dar la vuelta), vuelta a la realidad. Sustitución de otra dr. Pedí en la noche una infusión de marihuana,!, Resultado idéntico ........... dejarme muerto. Estoy a 15 mg / día de prednisona para muchas otras cosas relacionadas con SFC / EM, hasta el momento ha sido mi línea de vida cuando lo quito, sé que voy a tomar ........... .:(
 

6String

Member
I've had ME/CFS for 5 years now - and gone from 10% functionality (in bed for months with weird and Level 7 to 10 headaches, flu-like body aches, nausea and PEM) to now, at about 50% functionality. The headaches have never gone away and are the worst symptom now - down to an almost constant Level 2, spiking to 6 or 7.

After 15 different doctors (you all know the drill) and 20 different meds, the only one that works for me for break-thru pain is low-dose Percocet. I'm lucky - my PCP is open and experimental - willing to try almost anything for a few months and then reassess.

The CDC response to the national OD problem is understandable. But - "not one study has compared the benefits and harms of long term opioid use to other pain treatment option." That's really unbelievable.
 

Nancy

New Member
Interesting that they claim massage therapy us one of the things with a lower mean annual cost. I tried for years to get Blue Cross Blue Shield to cover the cost of my neuromuscular- trained massage therapist, and they said it hasn't been proven to have long- lasting benefits. However, they WILL pay for medications. (have to wonder how long- lasting are benefits from medications?). So, now the CDC is recommending therapies not paid for by most insurance plans....and their claims are not backed by studies....isn't that just typical?
 

Thobby

Member
Narcotics have never done a thing for my CFS/ME and fibro pain, but they have always been the only thing that would make the remnants of my shattered collarbone stop hurting in response to vibration. I've never taken them in the sort of huge doses that all the books seem to assume everyone does; I couldn't, I overreact to all medicines and I'd get sick as a dog if I tried. If I lived in a country, like Canada or Britain or New Zealand, where codeine was over-the-counter, my orthopedic chronic pain would be over, and without my even taking the maximum OTC dose. I know that from having travelled there. Codeine was the only thing that made long bus and train trips bearable. My shoulder would swell up around the collarbone-fragment as it was shaken by the bumps on the road, and it would hurt a great deal, but codeine kept the pain in check so that I could sightsee and enjoy my travels.

Here at home it's been a lot harder to combat my chronic pain. Darvocet used to work almost as well for me as codeine, but then the FDC banned it. NSAIDs tear up my stomach and make my already sun-sensitive skin so sensitive to ultraviolet that I have to stay indoors in the daytime (I can burn in five minutes in the summer, even before taking NSAIDs). Topical analgesics work as an adjunct but they don't solve the problem alone. I don't know of any physical therapy that would fix the fact that my collarbone is a jagged stump that vibrates in response to motors or music, or the related fact that my shoulder blade on that side tends to dislocate unexpectedly. Guided visualization, which is what I think they mean by behavioral therapies, has never done a lot for me, and I tried very hard to get it to work back when I first smashed my collarbone, as it was nearly impossible to get any sort of prescription pain relief until my problem was finally diagnosed four years after my accident.
 

Katie

Active Member
In my opinion opiods do not work when used every day on a long-term basis.

Now acute pain is different, opioids usually work very well and they're not needed for more than a few days or a week.

Part of the problem with long-term use of opiods (without a break) is the Mu-opiod receptors in the brain get "plugged up" that's the only way I can describe it-this is when tolerance happens. If higher and higher doses of opiods are needed then most likely tolerance has occurred and you need to wean off the opiods.

Perhaps just some people develop tolerance, I sure did. The very scary part was my doctor and a clinical pharmacist put me on fentynl, I was up to 100 mg (or mcg?) anyway way too high. There were a few nights my respirations were low and I was afraid to fall asleep. He is an expert in addictions and said "all people eventually develop tolerance when on long-term opiods".

I've also been on long-term slow-release morphine. It was ridiculous the way I actually craved the morphine. I was tapered off with liquid morphine-let me tell you that was very very hard but I'm a very stubborn person and was determined to get the "monkey off my back"

I go off all opiods under a specialist's care. I'll never go back on a long-term basis.
Some people are so afraid of the pain (and I hardly blame them, I get the same way at times) that the thought of going off opiods and really living with the raw pain is unthinkable, but in truth opiods may exacerbate chronic pain as it does with me when I'm on an opiod more than a few days.

However, I have taken morphine 5 mg or tramadol for acute pain, recently. My stomach gets messed up, I sweat like crazy and it does nothing for my chronic ME/CFS & FM pain. At least not enough to warrant staying on opiods.

Still the best med for me is cesamet (nabilone).

Please take note these are my opinions, based on my experience.
 
Last edited by a moderator:

Scribe52

New Member
I have used Norco (Vicodin) at various dosages for 5 years for fibromyalgia pain. It helps, and at times it helps a great deal. Because of other conditions, primarily Chronic Kidney disease and Bipolar I, there is a very limited list of medications I can use for pain, i.e. opiates, ketamine, cannabis, possible naloxone, so far opiates work best and I have not been able to find anyone where I live willing to experiment with low dose ketamine or naloxone. Over the past three and a half months I have reduced my opiate dose by about 1/6 to 1/3 on a daily basis, and so I think my doctor will continue to support my prescription. I feel fortunate than my general burden of pain has decreased quite a bit in the last few months, yet when it comes on it is at 6 to 8 waking me from sleep. If I didn't have something that worked I would be a mess. Thanks Cort for reviewing this very important subject!
 

Nancy

New Member
I swear when I first took Tramadol years ago, it was listed simply as an analgesic. Now it's called an opioid medication. Or an opiod analgesic. Must be one of the lowest on the opioid totem pole?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I swear when I first took Tramadol years ago, it was listed simply as an analgesic. Now it's called an opioid medication. Or an opiod analgesic. Must be one of the lowest on the opioid totem pole?
It is....it's different from the others...
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I've had ME/CFS for 5 years now - and gone from 10% functionality (in bed for months with weird and Level 7 to 10 headaches, flu-like body aches, nausea and PEM) to now, at about 50% functionality. The headaches have never gone away and are the worst symptom now - down to an almost constant Level 2, spiking to 6 or 7.

After 15 different doctors (you all know the drill) and 20 different meds, the only one that works for me for break-thru pain is low-dose Percocet. I'm lucky - my PCP is open and experimental - willing to try almost anything for a few months and then reassess.

The CDC response to the national OD problem is understandable. But - "not one study has compared the benefits and harms of long term opioid use to other pain treatment option." That's really unbelievable.
Sounds like you have a good PCP; glad the low-dose works :)
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I have used Norco (Vicodin) at various dosages for 5 years for fibromyalgia pain. It helps, and at times it helps a great deal. Because of other conditions, primarily Chronic Kidney disease and Bipolar I, there is a very limited list of medications I can use for pain, i.e. opiates, ketamine, cannabis, possible naloxone, so far opiates work best and I have not been able to find anyone where I live willing to experiment with low dose ketamine or naloxone. Over the past three and a half months I have reduced my opiate dose by about 1/6 to 1/3 on a daily basis, and so I think my doctor will continue to support my prescription. I feel fortunate than my general burden of pain has decreased quite a bit in the last few months, yet when it comes on it is at 6 to 8 waking me from sleep. If I didn't have something that worked I would be a mess. Thanks Cort for reviewing this very important subject!
Thanks. I think better pain drugs are in our future. Hopefully we'll see something significant and very different in the next five years or so..
 

fdotx

Well-Known Member
It is....it's different from the others...
I have been on 75mg (1.5pills) twice a day of tramadol for over 15 years so when news came out it was more addictive than previously thought, I took myself off for 2 weeks. For 1.5 days I felt a bit unpleasant but it was so mild and short term I went back on it since it does give me a lift but do keep it down to the 150mg total daily. As for the heavier stuff my doctor won't give me any more than 20 5mg Vicodin a year but I'm not in the pain a lot of you are - I feel for ya with the crackdown. I've recently seen a few shows on the heroin addiction sweeping the country so can somewhat understand doctors being cautious but still if a persons in pain.....
 

Lissa

Well-Known Member
My system has always been too sensitive for opiates. Vicodin & Percocet both make me vomit within a short time after taking it. Then when I was given an anti-nausea drug to counteract it, the Vicodin gave me horrible hallucinations.

When I tried to close my eyes and sleep, my brain was casting different images every millisecond, like a movie screen, but a different picture every single frame. And they were all super creepy... Random faces, bloody things, bright colors, patterns etc. NOT at all fun. It lasted for hours until it wore off.

Nope, my brain doesn't need drugs, no-sir-eee! I couldn't have cared less about the pain relief qualities--- the experience itself was awful enough to make opiates useless to me.

I tend to get by with Tylenol or rarely Aleve. NSAIDS tear up my stomach pretty fast. I try to use them sparingly for the worst pain, maybe once a week and hopefully only a couple times a month.
 

fdotx

Well-Known Member
My system has always been too sensitive for opiates. Vicodin & Percocet both make me vomit within a short time after taking it. Then when I was given an anti-nausea drug to counteract it, the Vicodin gave me horrible hallucinations.

When I tried to close my eyes and sleep, my brain was casting different images every millisecond, like a movie screen, but a different picture every single frame. And they were all super creepy... Random faces, bloody things, bright colors, patterns etc. NOT at all fun. It lasted for hours until it wore off.

Nope, my brain doesn't need drugs, no-sir-eee! I couldn't have cared less about the pain relief qualities--- the experience itself was awful enough to make opiates useless to me.

I tend to get by with Tylenol or rarely Aleve. NSAIDS tear up my stomach pretty fast. I try to use them sparingly for the worst pain, maybe once a week and hopefully only a couple times a month.
Lisa the brain reaction happened to me with pot - I was so happy when CO made it legal, imagining a good night's sleep and more natural way to combat pain/ feeling bad but instead was up all night, my brain feeling as if it were being tossed around at war - just miserable. Tried the CBD oil capsules but they did nothing.
 

Who Me?

Well-Known Member
Lisa the brain reaction happened to me with pot - I was so happy when CO made it legal, imagining a good night's sleep and more natural way to combat pain/ feeling bad but instead was up all night, my brain feeling as if it were being tossed around at war - just miserable. Tried the CBD oil capsules but they did nothing.
Maybe you need a different strain.
 

Issie

Well-Known Member
With Tramadol and Bentyl, I had to cycle on and off them or they wouldn't work. Being off these last two weeks, was my cycle off. This time, there hasn't been the feeling of withdrawal or the need to go back on them. I only used them at night to get out of pain enough to sleep. Also used when having a more severe epsoide of POTS. It helped with the over active autonomic symptoms. I'll keep them in hand for that. But excited how I'm doing so far off them.

Also being off the MCAS protocol is an amazing thing. I am still having it, but so far - as good off as I was on and I haven't needed an epipen.

Here is an interesting article I just got sent. I think you all will find it interesting.
http://relief.news/deciphering-chronic-low-back-pain/

Issie
 

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