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Thread: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

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    Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    A study just published in the Journal of the American Medical Association (JAMA) came to the conclusion that non-narcotic pain medications are equivalent to narcotics in control of chronic pain but don't have the side effects of death and severe disability that narcotics do.

    This would appear to provide hard data to support the idea that narcotics should not be used to control chronic pain.

    First of all, let me point out that they are not talking about acute pain, such as when you roll into the emergency room with a knife wound or a broken bone. Or the pain that you have just after hip surgery. Nobody is suggesting that narcotics should not be used for that kind of pain. We are talking here about pain that goes on for weeks, months, or years. So don't conflate treatment of acute pain with chronic pain.

    And we are not talking about severe pain from terminal cancer or other such diseases, in which the debilitating effects of the drug are not an issue.

    The problem with chronic use of narcotics is that they lose their effectiveness after a week or two and then they are no better than taking aspirin unless you bump the dose up. Then after two more weeks you have to bump the dose up again. Then again. And pretty soon you're dead with an overdose.

    Or maybe you take your usual dose of MS-Contin for the back pain and decide you'd like a slug of Jack to take some of the tenseness out of the day. Bang! you're dead with an overdose due to the combination. Or maybe you combine the morphine you take for fibroids with one of your husband's Valium tablets. Overdose and dead.

    And so it goes until tens of thousands of people have died from taking prescription narcotics.

    And if you manage not to OD there are still other effects of narcotics that were poorly appreciated until recently, like the way they sap all energy, verve, and ambition out of you until you're nothing more than this layabout blob with no hope of ever accomplishing anything. The deaths are just the tip of the iceberg. Under the water floats the specter of hundreds of thousands of burned out, wasted lives with ruined families and neglected children all due to chronic narcotic use.

    "The urge to save humanity is almost always a false front for the urge to rule." --HL Mencken

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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by LowDown View Post
    A study just published in the Journal of the American Medical Association (JAMA) came to the conclusion that non-narcotic pain medications are equivalent to narcotics in control of chronic pain but don't have the side effects of death and severe disability that narcotics do.

    This would appear to provide hard data to support the idea that narcotics should not be used to control chronic pain.

    First of all, let me point out that they are not talking about acute pain, such as when you roll into the emergency room with a knife wound or a broken bone. Or the pain that you have just after hip surgery. Nobody is suggesting that narcotics should not be used for that kind of pain. We are talking here about pain that goes on for weeks, months, or years. So don't conflate treatment of acute pain with chronic pain.

    And we are not talking about severe pain from terminal cancer or other such diseases, in which the debilitating effects of the drug are not an issue.

    The problem with chronic use of narcotics is that they lose their effectiveness after a week or two and then they are no better than taking aspirin unless you bump the dose up. Then after two more weeks you have to bump the dose up again. Then again. And pretty soon you're dead with an overdose.

    Or maybe you take your usual dose of MS-Contin for the back pain and decide you'd like a slug of Jack to take some of the tenseness out of the day. Bang! you're dead with an overdose due to the combination. Or maybe you combine the morphine you take for fibroids with one of your husband's Valium tablets. Overdose and dead.

    And so it goes until tens of thousands of people have died from taking prescription narcotics.

    And if you manage not to OD there are still other effects of narcotics that were poorly appreciated until recently, like the way they sap all energy, verve, and ambition out of you until you're nothing more than this layabout blob with no hope of ever accomplishing anything. The deaths are just the tip of the iceberg. Under the water floats the specter of hundreds of thousands of burned out, wasted lives with ruined families and neglected children all due to chronic narcotic use.
    Just to point out that the title that you used did NOT find that.

    The study actually found out that:

    The study authors cautioned that these results might not apply to pain patients in general, since VA patients aren't representative of the country as a whole.

    "Treatment with opioids compared with non-opioid medications did not result in significantly better pain-related function over 12 months," Krebs and her colleagues concluded. "Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain."
    So they did not say it was similar for pain.. but for certain types of pain from certain areas.

    In addition.. the study it found

    Patients in the opioid group had significantly more trouble with medication-related symptoms. However, hospitalizations and emergency room visits to deal with pain medications were similar in both groups, as were rates of drug misuse.
    So we should put you down as supporting putting GPS trackers in everyone to "save lives"?
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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by jaeger19 View Post
    Just to point out that the title that you used did NOT find that.

    The study actually found out that:

    The study authors cautioned that these results might not apply to pain patients in general, since VA patients aren't representative of the country as a whole.



    So they did not say it was similar for pain.. but for certain types of pain from certain areas.

    In addition.. the study it found
    Sorry, but there's no difference in chronic pain of different areas of the body.

    I'm not sure what is meant by "VA patients are not representative of patients as a whole." VA patients aren't human? VA patients are mostly men with the chronic pain problems of men - especially back pain. I don't think that's a substantive difference.

    The comment was nothing more that academic dicta. Of course further study is needed. Of course they need money for that further study.

    I think the onus has shifted to advocates of narcotic use to prove that narcotics provide a positive benefit that outweighs the horrible side effects of death and disability that they cause. Narcotics should not be used to treat chronic pain until proven otherwise.

    "The urge to save humanity is almost always a false front for the urge to rule." --HL Mencken

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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by LowDown View Post
    Sorry, but there's no difference in chronic pain of different areas of the body.

    I'm not sure what is meant by "VA patients are not representative of patients as a whole." VA patients aren't human? VA patients are mostly men with the chronic pain problems of men - especially back pain. I don't think that's a substantive difference.

    The comment was nothing more that academic dicta. Of course further study is needed. Of course they need money for that further study.

    I think the onus has shifted to advocates of narcotic use to prove that narcotics provide a positive benefit that outweighs the horrible side effects of death and disability that they cause. Narcotics should not be used to treat chronic pain until proven otherwise.
    sorry but there is very much a difference between chronic pain coming from a sciatic nerve.. and chronic pain in the knee from osteoarthritis.

    There very much is a difference between chronic pain from osteoarthritis, and chronic pain from lupus.

    So on an so forth.

    "VA patients are not representative of patients as a whole." VA patients aren't human?
    Because VA patients may have comorbidities like PTSD that;s not very present in the rest of the population.

    VA patients may be represent a population that has had more physical trauma.

    Va Patients may represent a population that is less likely to complain about pain, and more likely to say they are better than they actually are.

    I think the onus has shifted to advocates of narcotic use to prove that narcotics provide a positive benefit that outweighs the horrible side effects of death and disability that they cause
    Did you notice that in both populations.. narcotic and non narcotic..

    However, hospitalizations and emergency room visits to deal with pain medications were similar in both groups, as were rates of drug misuse.
    Narcotics should not be used to treat chronic pain until proven otherwise.
    wrong. The evidence on this study is that if chronic pain is due to osteoarthritis in the knee or back, that narcotics should probably not be the first choice to treat the pain.

    NOT that "chronic pain" in general should not be treated with opioids.
    So we should put you down as supporting putting GPS trackers in everyone to "save lives"?
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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by jaeger19 View Post
    sorry but there is very much a difference between chronic pain coming from a sciatic nerve.. and chronic pain in the knee from osteoarthritis.

    There very much is a difference between chronic pain from osteoarthritis, and chronic pain from lupus.

    So on an so forth.
    Wrong, wrong and wrong.



    Because VA patients may have comorbidities like PTSD that;s not very present in the rest of the population.
    Wrong. PTSD is prevalent in the general population, too, and there's no evidence it would impact pain control anyway.

    VA patients may be represent a population that has had more physical trauma.

    Va Patients may represent a population that is less likely to complain about pain, and more likely to say they are better than they actually are.
    Wrong and wrong again.





    Did you notice that in both populations.. narcotic and non narcotic..





    wrong. The evidence on this study is that if chronic pain is due to osteoarthritis in the knee or back, that narcotics should probably not be the first choice to treat the pain.

    NOT that "chronic pain" in general should not be treated with opioids.
    I'm not sure what proportion of chronic pain is knee and back pain. I'll bet it's a pretty large one.

    Regardless, narcotics control the symptom of pain only and have no effect on the root cause of the pain. As such they can be applied to any kind of pain. Most non-narcotic pain medications are the same. Other pain medications, like NSAIDS, have other effects that may interrupt the root causes of the pain and may work better for certain problems, but most chronic pain is not of this sort.

    Sorry, but I see the day rapidly approaching when patients with simple chronic pain not due to terminal cancer or the like will be told that they have to come off of the narcotics.

    If a person is offered a choice between two pain medications that work equally well, one that has serious side effects including death and the other much safer, which would the rational person choose? Why would anyone ever choose otherwise? What is going on that would make them make an irrational choice?

    "The urge to save humanity is almost always a false front for the urge to rule." --HL Mencken

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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by LowDown View Post
    Wrong, wrong and wrong.


    ?
    right right right.

    Currently, Veterans are more likely than non-Veterans to be male, and are on average much older. We estimate that approximately 92 percent of the Veteran population was male in 2014. We also estimate that 75 percent of Veterans were age 55 or older, compared with only 34 percent of the non-Veteran population.
    For example, the fact that Veterans have a much higher rate of diabetes than non-Veterans is useful for determining the types of providers and services that Veterans need,
    https://www.va.gov/opa/choiceact/doc...mographics.pdf

    After controlling for age and other factors (Figure ES-4), Veterans are 13.5 times more likely than non-Veterans to be diagnosed with PTSD
    The prevalence of PTSD is substantially elevated in patients with chronic pain. A current PTSD prevalence of 35% was seen in a sample of chronic pain patients (13), compared to 3.5% in the general population (14). In a study of patients with chronic low back pain, 51% of the patients evidenced significant PTSD symptoms (15). In another study of patients who experienced chronic pain following a motor vehicle accident, researchers found that 50% of the patients developed PTSD (16).

    One symptom of PTSD is that the person becomes emotionally or physically upset when reminded of the traumatic event. For people with chronic pain, the pain may actually serve as a reminder of the traumatic event, which will tend to exacerbate the PTSD.
    https://www.ptsd.va.gov/professional...-providers.asp

    Regardless, narcotics control the symptom of pain only and have no effect on the root cause of the pain.
    True.. however in cases of chronic pain.. many times there is no or little way to improve the root cause of pain especially completely.

    Sorry, but I see the day rapidly approaching when patients with simple chronic pain not due to terminal cancer or the like will be told that they have to come off of the narcotics.
    Yep.. that has been done and what happened is that the number of deaths from overdose of opiods went down. Yeah..!

    Except that in the same instance, deaths from overdose of heroin went dramatically up.. to the point where the total number of overdose deaths increased.

    So what happened is that the restrictions on narcotics, pushed people into heroin and their local drug dealer to deal with their pain.. and they ended up overdosing because of the uncontrolled quality of heroin.

    If a person is offered a choice between two pain medications that work equally well, one that has serious side effects including death and the other much safer, which would the rational person choose?
    Did you notice that the number of emergency visits, and overdoses were the same in both groups in the study.??

    However, hospitalizations and emergency room visits to deal with pain medications were similar in both groups, as were rates of drug misuse.
    Most of the time. opiods aren't an "irrational" choice.

    Do you think the vast number of physicians are "irrational" and don't care about their patients well being?
    So we should put you down as supporting putting GPS trackers in everyone to "save lives"?
    Vegas Giants: "Sounds fantastic!"

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    Re: Narcotics are No Better at Controlling Chronic Pain Than Non-Narcotics

    Quote Originally Posted by LowDown View Post
    A study just published in the Journal of the American Medical Association (JAMA) came to the conclusion that non-narcotic pain medications are equivalent to narcotics in control of chronic pain but don't have the side effects of death and severe disability that narcotics do.

    This would appear to provide hard data to support the idea that narcotics should not be used to control chronic pain.

    First of all, let me point out that they are not talking about acute pain, such as when you roll into the emergency room with a knife wound or a broken bone. Or the pain that you have just after hip surgery. Nobody is suggesting that narcotics should not be used for that kind of pain. We are talking here about pain that goes on for weeks, months, or years. So don't conflate treatment of acute pain with chronic pain.

    And we are not talking about severe pain from terminal cancer or other such diseases, in which the debilitating effects of the drug are not an issue.

    The problem with chronic use of narcotics is that they lose their effectiveness after a week or two and then they are no better than taking aspirin unless you bump the dose up. Then after two more weeks you have to bump the dose up again. Then again. And pretty soon you're dead with an overdose.

    Or maybe you take your usual dose of MS-Contin for the back pain and decide you'd like a slug of Jack to take some of the tenseness out of the day. Bang! you're dead with an overdose due to the combination. Or maybe you combine the morphine you take for fibroids with one of your husband's Valium tablets. Overdose and dead.

    And so it goes until tens of thousands of people have died from taking prescription narcotics.

    And if you manage not to OD there are still other effects of narcotics that were poorly appreciated until recently, like the way they sap all energy, verve, and ambition out of you until you're nothing more than this layabout blob with no hope of ever accomplishing anything. The deaths are just the tip of the iceberg. Under the water floats the specter of hundreds of thousands of burned out, wasted lives with ruined families and neglected children all due to chronic narcotic use.

    You dont know anyone with chronic pain, do you? My brother is on opioids, has been for 10 years after a lumber jacking incident. Yes, tolerance increases, but it's years slower than a few weeks. With it, he runs the risk of dying, but he's careful about it, and if it shortens his life, well, without them he'd commit suicide.

    Apparently the pencil pushing morons cannot grasp this. Where do you get this "lay-about-blob" BS. My brother runs a business.

    And no, aspirin and/or over-the-counter anything just doesn't work. I'm no fan of opioids, but my brother tells me, "hey, I'll let you live with my pain for one frickin' day, and then you come back and tell me to take aspirin, so F you, bro' "


    IF you are smart about using it, you'll be okay. If you're stupid about it, you'll get hurt or die.

    Thing is, if you're stupid about a lot of things, such as driving, you can get killed, as well. Are you recommending doing away with cars?

    Just be smart, you don't have to be stupid, it's a choice.

    I've got headaches, several per week, I'm on sumatriptan, it works fine, but for my brother, he takes that and more, his headaches are far worse, he takes methadone and morphine and sumatriptan and excedrin, he needs all of them for any of them to work. Head injury, 24/7 pain. Life's rough, and I don't criticize him for not wanting to live with pain. Until you can walk in someone shoes that has this kind of pain, you have no right to tell them not to seek relief. Life is hell when you're in pain, trust me on that one.
    Last edited by OscarLevant; 03-19-18 at 06:54 AM.
    And the core of conservatism is the foolish notion that "small government" is a noble goal. Makes a nice sound bite, but when you examine their policy proposals in pursuit of small government, it's always some variant of more goodies for rich people, and less goodies for poor people, either that or an intrusion into women's vaginas.

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