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

Seeksassy

Active Member
I get SO incredibly angry when any organization like the CDC speaks from above and makes declarations they know nothing about. First, I am alive today because of Opioid pain relievers. I was a depressed, lifeless person. Spending lonely and painful days, day after day. Never having any hope. There was no light at the end of the tunnel for me. No great cure right around the corner. And doctor after doctor, afraid to deal with Chronic Pain issues because doctors fear what they can not fix. I was like that for over 3 years, following one horrible year of almost dying 3 times. First there was Cancer, 3 months later 4 Pulmonary Embolisms and Open Heart Surgery a few months later. My body was so damaged and I just never recovered. Tired at first and then came the pain. Lost the support of friends and family, they didn't understand. This is nothing new, thousands of us lose everything. But the CDC doesn't understand or care about any of that. They are worried only about taking away the very thing that has brought life back to me and so many others.
People who suffer chronic pain look at Opioids differently, they are our savior. I speak only for me and those people I know who finally just made the decision to let these medicines help us. I would never abuse my Methadone because with it I can function. With it I can shower, I can do laundry, I can keep my house clean (mostly) and I can almost work. Methadone gives me a ton of energy....a ton! I never get high, instead my fog lifts and I can read again. I have found a new form of art which gives me joy and may even be a way to make a living. NONE of this would have been possible if I hadn't finally given in and taken Methadone. Again, I would never abuse what has saved me.
The problem of people overdosing on prescription drugs isn't the fault of chronic pain sufferers. In fact, Frontline, the critically acclaimed PBS series, did a great story about how the rise of Heroin abuse in this country is a direct result of such organizations clamping down on prescription pain killers. The White House was warned that if this pressure continued that Heroin use would sky rocket. The Mexican drug cartels were already setting up supplies in middle to upper class white suburban areas to get the Heroin flowing once the tap of prescription drugs stopped. In their special Chasing Heroin, Frontline followed a small suburb of Seattle as the town fell into the clutches of Heroin. I think the CDC should watch Chasing Heroin so they can see the result of their work. I wouldn't care so much if I weren't directly in the line of fire.
Having my life back, at least 60% back, I am terrified that one day my doctor will tell me she can no longer provide Methadone to me. I've even researched methadone clinics, that's how much I refuse to go back to the person I was when I was lying in bed, in pain and depressed. I refused to lose myself again. I even cut my dose on my own because of G.I. side effects.
I will note that I suffer from Fibromyalgia, not ME. Although I feel there are more similarities than differences between us, I am unfamiliar with how much constant pain ME suffers actually deal with. I do know that it all affected me, the pain, the fog, the exhaustion, the depression all of it. And Methadone has helped me with all of it. I really wish the CDC would stick to controlling disease and leave prescribing the drugs to the doctors.

Without the transdermal fentanyl I take for CRPS, I believe I wouldn't be alive. Although I can't say it gives me any energy, I am able to walk unaided only because of this drug, and live without the acute pain of CRPS, although it does nothing for my FM pain. I don't understand why these people can't discern the difference between drug abusers and those who legitimately require opioids. We are 2 such different populations. It sounds to me as though some docs are prescribing opioids as the first line of treatment, which I don't believe can be a best practice. So providing docs with guidelines for treating pain, with opioids as the last resort, seems appropriate to me. But to deny appropriate monitored treatment to anyone, when it is readily available, and safe when used as intended, is cruel.
 

Seeksassy

Active Member
Just the word Tramadol makes me shudder. I took tramadol to control the headaches that came with Fibromyalgia. I was a migraine sufferer for most of my life, but these headaches were different and helped by Tramadol. Until one day I took it and began hallucinating while driving. This was after getting really sick when I had taken it the week before. I started feeling funny and had to go right to bed. Well the hallucinations started, I managed to get myself home and starting making phone calls while I was still coherent. My mom rushed over to help me and I became extremely ill. The hallucinations continued as I was writhing in pain. My poor mom trying everything she could as I thought she was hurting me. Turns out I had become allergic to Tramadol. This had happened to me before with Vicodin, no hallucinations, but a sudden allergy.
Wow, pretty scary. I, too, had problems with tramadol, 2 seizures. Disappointing as it was one of the few things that helped my FM pain.
 

Seeksassy

Active Member
Dr. Clauw - well-known FM researcher just published this
https://www.ncbi.nlm.nih.gov/pubmed/26975749


Mayo Clin Proc. 2016 Mar 11. pii: S0025-6196(16)00102-6. doi: 10.1016/j.mayocp.2016.02.002. [Epub ahead of print]Opioid Use in Fibromyalgia: A Cautionary Tale. Goldenberg DL1, Clauw DJ2, Palmer RE3, Clair AG3.

Abstract

Multiple pharmacotherapies are available for the treatment of fibromyalgia (FM), including opioid analgesics. We postulate that the mechanism of action of traditional opioids predicts their lack of efficacy in FM. Literature searches of the MEDLINE and Cochrane Library databases were conducted using the search term opioid AND fibromyalgia to identify relevant articles, with no date limitations set. Citation lists in returned articles and personal archives of references were also examined for additional relevant items, and articles were selected based on the expert opinions of the authors.

We found no evidence from clinical trials that opioids are effective for the treatment of FM. Observational studies have found that patients with FM receiving opioids have poorer outcomes than patients receiving nonopioids, and FM guidelines recommend against the use of opioid analgesics.

Despite this, and despite the availability of alternative Food and Drug Administration-approved pharmacotherapies and the efficacy of nonpharmacologic therapies, opioids are commonly used in the treatment of FM. Factors associated with opioid use include female sex; geographic variation; psychological factors; a history of opioid use, misuse, or abuse; and patient or physician preference. The long-term use of opioid analgesics is of particular concern in the United States given the ongoing public health emergency relating to excess prescription opioid consumption.

The continued use of opioids to treat FM despite a proven lack of efficacy, lack of support from treatment guidelines, and the availability of approved pharmacotherapy options provides a cautionary tale for their use in other chronic pain conditions.
I have to disagree. Not all chronic pain conditions are the same. I have ME/CFS and FM, and bursitis, and CRPS. For me, opioids work only for the CRPS, and work well. Why do so many "experts" insist on lumping all chronic pain conditions together? It's as bad as treating all opioid users as addicts, when that's obviously not true. I don't get it. Twenty years ago, when opioids were first prescribed for me, I thought like this. But I was a lay person who had no experience with opioids. My pain specialists at the time went to great lengths to convince me of the difference between addiction and dependence, and my own research, way back then, backed it up. Now, because of the epidemic of opioid abuse, or misuse, the "experts" act as if there is no legitimate use for opioids except for the dying or cancer pain. I'm starting to feel like I should hide my use of the only drug that allows me to even walk. I worry people will think I'm an addict if they know I use fentanyl. If doctors and "experts" think this, why wouldn't everybody else? I am feeling extremely resentful.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I have to disagree. Not all chronic pain conditions are the same. I have ME/CFS and FM, and bursitis, and CRPS. For me, opioids work only for the CRPS, and work well. Why do so many "experts" insist on lumping all chronic pain conditions together? It's as bad as treating all opioid users as addicts, when that's obviously not true. I don't get it. Twenty years ago, when opioids were first prescribed for me, I thought like this. But I was a lay person who had no experience with opioids. My pain specialists at the time went to great lengths to convince me of the difference between addiction and dependence, and my own research, way back then, backed it up. Now, because of the epidemic of opioid abuse, or misuse, the "experts" act as if there is no legitimate use for opioids except for the dying or cancer pain. I'm starting to feel like I should hide my use of the only drug that allows me to even walk. I worry people will think I'm an addict if they know I use fentanyl. If doctors and "experts" think this, why wouldn't everybody else? I am feeling extremely resentful.
Too much lumping I agree. I think the tide has turned one way - they are very focused on stopping deaths due to improper painkiller use - and it will turn back in time. In meantime check a blog coming up tomorrow on the new opiate drugs being developed that may be stronger and not cause side effects....(!)
 

Seeksassy

Active Member
It's great that pain is getting much needed attention which will hopefully result in safer and better treatments. I'm excited at the prospect of the new opioids, as per your great post, Cort.
 

Mary Hamilton

Active 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]View attachment 1150 [/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.
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.
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.
[fleft]View attachment 1149 [/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.
It's funny how doctors who have never had chronic pain think people do not need opioids but some who have been diagnosed with fibromyalgia have said they were so wrong!!!
 
Last edited:

EvzRib

New Member
The problem is that most people do not understand that the CDC DOES NOT HAVE THE AUTHORITY to tell doctors how to prescribe any medications. They can "recommend" and of course in the last month in particular, the media has turned this into a "Witch Hunt" and some doctors have simply abandoned their patients, taking away their pain medications and leaving them out in the street to withdraw on their own. This is not only abusive and dangerous, it is illegal, according to the AMA. I've spoken with at least 8 people over the last few weeks all over the United States who have had this horrid thing happen to them. Doctors aren't reading the words correctly. There is a difference between "recommendation" and "law". That being said, any patient who abuses their medication can be dismissed by their doctor, but these are not cases of abuse, these are cases of doctors being given the wrong information. As long as they are licensed properly and as long as they are not selling narcotics/opiates to anyone who walks in their office, they can prescribe as they see fit.
There is also another problem with corporations that doctors have to answer to if they are under their umbrella. These corporations need to get their facts straight as well before passing down "their" interpretation to their doctors.
The CDC can certainly put a lot of pressure on other government organizations but the FDA makes the laws for medications.
In addition, if this isn't enough and for whatever political reasons, the CDC has long been invalidating the existence of chronic pain. M.E./CFS has become a pandemic over the last 30 years. Children, teens, young adults are wasted by this disease and still they avoid taking the proper action for proper treatment. By their apathy, they have created this monster of a disease and then we get thrown under the political bus when we have to turn to pain medication for management. Neuro drugs are thrown into the population like skittles and have just as many, if not more side effects than pain medications.
Chronic Pain Patients are not the problem. Myth and misinformation are. I would suggest contacting your State AMA and your State Representatives and voice your outrage regarding this snow ball effect this is starting to have on our population. The CDC is not the last word on this subject but the media is certainly making it sound like they are.
 

Mary Hamilton

Active Member
The problem is that most people do not understand that the CDC DOES NOT HAVE THE AUTHORITY to tell doctors how to prescribe any medications. They can "recommend" and of course in the last month in particular, the media has turned this into a "Witch Hunt" and some doctors have simply abandoned their patients, taking away their pain medications and leaving them out in the street to withdraw on their own. This is not only abusive and dangerous, it is illegal, according to the AMA. I've spoken with at least 8 people over the last few weeks all over the United States who have had this horrid thing happen to them. Doctors aren't reading the words correctly. There is a difference between "recommendation" and "law". That being said, any patient who abuses their medication can be dismissed by their doctor, but these are not cases of abuse, these are cases of doctors being given the wrong information. As long as they are licensed properly and as long as they are not selling narcotics/opiates to anyone who walks in their office, they can prescribe as they see fit.
There is also another problem with corporations that doctors have to answer to if they are under their umbrella. These corporations need to get their facts straight as well before passing down "their" interpretation to their doctors.
The CDC can certainly put a lot of pressure on other government organizations but the FDA makes the laws for medications.
In addition, if this isn't enough and for whatever political reasons, the CDC has long been invalidating the existence of chronic pain. M.E./CFS has become a pandemic over the last 30 years. Children, teens, young adults are wasted by this disease and still they avoid taking the proper action for proper treatment. By their apathy, they have created this monster of a disease and then we get thrown under the political bus when we have to turn to pain medication for management. Neuro drugs are thrown into the population like skittles and have just as many, if not more side effects than pain medications.
Chronic Pain Patients are not the problem. Myth and misinformation are. I would suggest contacting your State AMA and your State Representatives and voice your outrage regarding this snow ball effect this is starting to have on our population. The CDC is not the last word on this subject but the media is certainly making it sound like they are.
Thank you for posting this!
 

David Downer

New Member
Dr. Clauw - well-known FM researcher just published this
https://www.ncbi.nlm.nih.gov/pubmed/26975749


Mayo Clin Proc. 2016 Mar 11. pii: S0025-6196(16)00102-6. doi: 10.1016/j.mayocp.2016.02.002. [Epub ahead of print]Opioid Use in Fibromyalgia: A Cautionary Tale. Goldenberg DL1, Clauw DJ2, Palmer RE3, Clair AG3.

Abstract

Multiple pharmacotherapies are available for the treatment of fibromyalgia (FM), including opioid analgesics. We postulate that the mechanism of action of traditional opioids predicts their lack of efficacy in FM. Literature searches of the MEDLINE and Cochrane Library databases were conducted using the search term opioid AND fibromyalgia to identify relevant articles, with no date limitations set. Citation lists in returned articles and personal archives of references were also examined for additional relevant items, and articles were selected based on the expert opinions of the authors.

We found no evidence from clinical trials that opioids are effective for the treatment of FM. Observational studies have found that patients with FM receiving opioids have poorer outcomes than patients receiving nonopioids, and FM guidelines recommend against the use of opioid analgesics.

Despite this, and despite the availability of alternative Food and Drug Administration-approved pharmacotherapies and the efficacy of nonpharmacologic therapies, opioids are commonly used in the treatment of FM. Factors associated with opioid use include female sex; geographic variation; psychological factors; a history of opioid use, misuse, or abuse; and patient or physician preference. The long-term use of opioid analgesics is of particular concern in the United States given the ongoing public health emergency relating to excess prescription opioid consumption.

The continued use of opioids to treat FM despite a proven lack of efficacy, lack of support from treatment guidelines, and the availability of approved pharmacotherapy options provides a cautionary tale for their use in other chronic pain conditions.
I have ME/CFS with serious Brain Swelling issues and all over joint and muscle pain along with so many other symptoms and i have been on Fentynol Transdermal Patch 75 mg which i change out patch every two days due to the pain severity between 7-10.I use 3 boxes of five patches a month and also have to use Oxycodone 10-325 mg when pain and brain swelling becomes unberable for me.I only use the oxycodone/acetaminiphine 10/325 only when i need to so 120 qty last me 60 days or so.I have ME/CFS severly and have been sick with a diagnosis with fibromyalgia since yr 2000 but was able to work then.I contracted the Epstein Barr Virous in Oct 1,2008 and spent next 4 years in bed and have never recovered.I am presently taking 3/20 mg Amphamines daily to help deal with the fatigue and drink coffee when i need to drive so i am able to stay a wake.I also am taking supplements 2 types of B-12 and also B-12 injections and Testostorone injections weekly.Taking Co Q10,Warafin Blood Thinner for DVT,Blood Pressure for high blood disorder abd few other meds and supplements.I am allways looking to try to cure myself without such luck.I can tell you that for the Brain Swelling it gets so bad that my Temples swell out and i get bug eyes due to the amout of swelling i deal with at times.I have to use ice pacs on temples to help bring down swelling.Does anyone else know what medication may help me with the Brain Swelling and inflamation?I can also tell you that without opioids pain management i would npot be here today because i could not bear to live with this much pain i feel in this body.
 

Who Me?

Well-Known Member
@David Downer Welcome, for those of us with neuro problems could you please edit your post and put in some paragraphs? No way can I read that huge chunk of text. Thank you. @Cort, help please
 

Onslow

Active Member
I have ME/CFS with serious Brain Swelling issues

How were you diagnosed with brain swelling? That's not typical of CFS, from what I understand.

Regarding opioids: there isn't any evidence that long-term opioids are effective, and the science tells us that they won't be effective. The problem is that the brain builds up a tolerance, so after a while the opioids will have zero effect and you'll need to take a stronger and stronger dose. Most health authorities recommend against strong opioids for fibromyalgia and chronic pain.

As a patient you really should be looking for something more effective.

Oh, and the CDC and NIH are doing a lot of research into chronic pain. I was just reading an NIH funded review of central sensitization the other day.
 
I've had the same terrific doctor for almost 30 years and he has no problem with prescribing pain meds for me knowing that I'll only use one when truly needed. I also live in a remote area and can't run to the emergency room for a shot if needed. In addition to the pain of FM & Me/CFS I have a lot of pain from repeated surgeries (that failed) on one foot and the other foot has ever worsening arthritic gout in its joints. What I have on hand is tylenol 4 which I cut in half to reduce the amount of tylenol and still have enough codeine to actually help the pain. I can make a prescription of 40 pills last almost 4 months or more. I am concerned that these yahoos are going to make it more difficult to get the only thing that helps quiet some of my pain :(
 

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