Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network




A Comprehensive Review of Opioid-Induced Hyperalgesia

4.2 Clinical Evidence
Similar to basic science evidence, supporting clinical evidence has also been established (14,21,30,43-55). Clinical OIH has been described after intraoperative remifentanil infusion (30), in patients with detoxification from high dose opioids with improvement in pain (43), and increased pain sensitivity with methadone (21).

…6.4 Practical Considerations
The treatment of OIH can be time-consuming and at times, impractical. Weaning patients from high dose opioids usually requires time and patience (for both the physician and patient). While reducing the opioid dose, patients might experience transient increases in pain or mild withdrawal which can exacerbate pain. The hyperalgesic effect might not be mitigated until a certain critical dose of opioid is reached.

(21) Compton P, Charuvastra VC, Ling W. Pain intolerance in opioid-maintained former opiate addicts: Effect of longacting maintenance agent. Drug Alcohol Depend 2001; 63:139-146.

(43) Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high dose opioids. J Opioid Manag 2006; 2:277-282

(45) Hay JL, White JM, Bochner F, Somogyi AA, Semple TJ, Rounsefell B. Hyperalgesia in opioid-managed chronic painand opioid-dependent patients. J Pain 2009; 10:316-322.
(47) Fishbain DA, Cole B, Lewis JE, Gao J, Rosomoff RS. Do opioids induce hyperalgesia in humans? An evidence-based structured review. Pain Med 2009; 10:829-839.

(48) Mitra S. Opioid-induced hyperalgesia:Pathophysiology and clinical implications. J Opioid Manage 2008; 4:123-130.
(49) Cohen SP, Christo PJ, Wang S, Chen L, Stojanovic MP, Shields CH, Brummett C, Mao J. The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus. Reg Anesth Pain Med 2008; 33:199-206.

A Comprehensive Review of Opioid-Induced Hyperalgesia 

There appears to be some connection with withdrawal and experiencing the sensation of pain. According to the above, continued opioid use has the capacity to increase the level of pain a subject experiences.

So…. when we are giving pain medicine recipients turn opioid dependent people more opioids, like methadone, wouldn’t it follow that we -in effect- worsening the pain problem they had originally? …And the longer they are on opioids, the worse their pain situation and the further into addiction they are sent?

Gallery Owner Arrested After Dropping Sculpture Of Giant Drug Spoon At Purdue Pharma

A Stamford art gallery owner was arrested and charged with a criminal misdemeanor and a felony Friday morning after dropping an 800-pound steel sculpture of a bent, burnt heroin spoon in front of Purdue Pharma, a top manufacturer of opioids, and then refusing to remove it.

…Alvarez said the sculpture and its placement are a statement intended to create a groundswell of outrage against Purdue and the billionaire Sackler family, who are majority owners of the company, which developed OxyContin.

…The interactions between Alvarez and police were cordial. While waiting to issue the summons, the gallerist and the cops chatted amiably about civic matters and the opioid epidemic.

The sculpture, named “Purdue,” was made by Boston-based artist Domenic Esposito, who was present at the time of the sculpture drop. Esposito was not charged or arrested. He said before the art drop that he and Alvarez decided who would take the criminal charges.

Esposito said he was was inspired to create the artwork by his brother’s drug addiction. Esposito said his brother started with OxyContin and Percocet and moved to heroin.

Gallery Owner Arrested After Dropping Sculpture Of Giant Drug Spoon At Purdue Pharma – Hartford Courant

Heh, nice.

US Health Officials’ New Plan to Fight the Opioid Crisis: Stop Chronic Pain Before It Starts

The plan is comprised of two main parts: funding for projects that will help develop or facilitate treatments for opioid addiction and overdose, and funding for programs meant to improve the management of pain via research into how acute pain becomes chronic pain (with the hope that someday we can stop that from happening), as well as the development of new, nonaddictive pain treatments.

…For instance, though there are three approved drugs to help people wean off opioids (methadone, buprenorphine, and naltrexone), Collins and the others note that most people living with opioid addiction never actually get started on these treatments, and of those who do, 50 percent relapse within half a year.

“Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have opioid use disorder,” the authors wrote.

US Health Officials’ New Plan to Fight the Opioid Crisis: Stop Chronic Pain Before It Starts