Why can't we make nonaddictive painkilllers?

[Dr J]

The problem aren't the drugs themselves, it's the fact they're over-prescribed. The US consumes massive quantities of painkillers compared to other western countries, where doctors prescribe them only when absolutely necessary.

There are a few problems here. One is obviously the crooked physicians who are essentially selling prescriptions for cash and other kick backs. Many states have begun cracking down on these pill mills with good results.

Another big issue is a lack of training. It's amazing how little training that family practitioners/internal med docs actually get in medical school and residency when it comes to pain management.

Lastly, there is also an issue with patient satisfaction ratings. Reimbursement can even be tied in to these. Patients who get turned down for narcotics tend to complain and/or take to the internet to blast physicians, who can't defend themselves due to HIPPA restraints. The emergency rooms are essentially drug dens, as well. Ever since pain became the 5th vital sign, patients seemingly received the right to be in no pain whatsoever. A patient comes in screaming of 10/10 pain, most often than not they get their morphine or Dilaudid (along with their IV Phenergan and Benadryl).

 

[InternetHero]

It's not just the mind, as many people addicted are addicted in a chemical sense, not a psychological sense (the latter tends to occur more often in abusers). In the case of opioids, there is receptor upregulation--block the receptors, and the body creates more.

As far as the original point goes, there are plenty of non-addictive pain medications for aches, neuropathic pain, and pain due to inflammation. The big issue is that most people want to be pain free and not just have pain relieved to make them more functional, and that is the big demand from patients.

There is much more that goes into chronic pain than a simple insult to tissue. There are behavioral components and centers sensitization that makes it difficult to simply block a physiological pathway. This is why some pain centers take a multi-disciplinary approach and bring in psychologists/psychiatrists to assist--though the lack of mental health coverage makes it difficult for patients to get this kind of care. Add all this to the fact that it's just not easy to localize medication to a particular area without causing other systemic problems--the same problem we see with chemotherapies. There are options such as localized steroid injections and nerve ablations that can help with peripheral and axial joint pain; but these are much less effective when it comes to combating disc pain.

Surely, and good explanation.

 

[feedmelies]

Lol..no..I didn't do yoga till years later... like seven years after accident(spiral break of femur..dirt bike)

I'd laughed my ass off had someone recommended that earlier in recovery.

My job(construction/Steel framing carpenter) has also been rough on my body...shoulder surgery(rotator torn) ...bad knee...bad back..

The yoga helps loosen the tight muscles and joints..I wouldn't say it takes pain away but does seem to help with the stiffness..

The Norcs make the pain go away..for about 3-4 hour spurts. But I'm really to the point were I have to make a decision..quit or have the surgery that kills the nerves

Are you still having Norco prescribed?

 

[feedmelies]

The people talking about aspirin, ibuprofen, etc... I doubt have had to experience any type of significant chronic pain. Last year I began to develop some back issues while off work (due to another injury). I was flat out miserable with only those options available. When I finally got back to work, gained insurance, and was prescribed stronger painkillers... it was a life changer. I only took them at night, also. I could deal with it during the day with over the counter options, but just having the relief at the end of the day made a substantial difference.

I am curious about the pot stuff though. Never done it, and I don't think I ever will, even though it's becoming decriminalized here. Has anyone transitioned off of an opioid medication to something like medical marijuana or CBD oil for chronic pain? How did they compare? Even people in here are saying they aren't on the same level. I am wondering how realistic that would be.

 

[Ice That Jaw]

Tramadol is supposed to be less addictive than oxy because it does something to your seritonin levels. It still gives you a very slight high though so im sure you can get mentally hooked pretty easily.

 

[Shamrocker]

Maybe over prescribing but definitely over abusing.

 

[helltoupee]

Here in Houston we have had a huge problem with the pain clinics/pill mills - while Tampa was the main hub for oxycontin prescriptions, Houston mirrored it with tons of pain clinics prescribing hydrocodone, carisoprodol (soma), and xanax. It was to the point where you could go to two, three clinics a day and be prescribed 120 lorcets, 90 soma, and 60 xanax as long as you had the money for the office visit and prescription. In the past few years they've tightened the restrictions on prescribing and shut-down a lot of the clinics, but they're still out there and prices for office visits - cash only, no insurance - have gone way up. A lot of the clinics operating now will prescribe Tylenol 4 for pain and still give soma, but a lot of people I know hooked on the shit have now switched to heroin or suboxone - a few who are into the "soma coma" just take the Tylenol 4's in place of the hydrocodone and these people are just lost, I don't know how many friends I've cut out of my life who choose to zombify themselves on this crap.

What gets me are the suboxone docs, this a big money-maker here now that there are so many addicts - most office visits will be @ $500 for the initial visit, they prescribe suboxone and adderall, sometimes they'll throw a benzo in for good measure - they'll tell you the adderall will give you the energy/boost the pain pills did so you can get through the day - it is a total racket.

I've been on suboxone for some time now, I love it and hate it. I got hooked on hydrocodone after injuring myself in a freak accident while prepping for a powerlfting meet in 2000 and developed severe sciatica. I hated the way hydrocodone made me feel at first but it took the pain away and after a while, the feeling switched from making me feel muddy, to euphoria and a really good boost of energy...and I fell in love with it. Fast-forward to 2011, my little brother had passed-away, I moved back to Houston, was partying a lot, and the pills were so easily obtained that my intake went WAY up, up to the point where I was taking 25 lorcets a day and I was worried about my liver due to all of the acetaminophen. The suboxone takes all of the cravings away and will get you off of pain pills, but you're going to withdrawal once you're on it and you're basically trading one addiction for another. If I could go back and do one thing, I'd never touch opiates.

Hey brother. I've been where you are.

I went down a few times on the motorcycle, got prescribed painkillers, including methadone, which I was on for 4 years. I was supposed to go the suboxone route to get off the methadone, but due to cost and worry about just having another habit to break - I walked away from my doctor's office without titrating down as you should.

Due to the half-life in methadone and suboxone, they are very very hard to get off of, and as you noted, expensive.

What I wanted to tell you is that I was able to quit without any problems - and walked off of 155mg methadone/day.

What I did was I went to Costco/Sam's Club and bought generic loperamide (Immodium) - 400 pills for about $7.

Loperamide is an opioid that does not cross the blood brain barrier, and won't get you high, but it binds to the opioid receptors in the body which are responsible for the withdrawals. You can take this as a substitute, and titrate it down until you don't need it anymore. How many you will need to take depends on your current suboxone dosage/tolerance. I've been completely clean for 5 years, and never dealt with any withdrawals.

PM me if you have any questions. You could also use Kratom - but it's more expensive, and poppy seed tea - which is kind of a chore to make, both of which you would use to titrate down.

 

[DoomPatrol]

They have those nowadays. Usually a Suboxone program.

For today's addicts you have a variety of options to get help.

Say 5 or even 10 years ago the difference is night and day.

The only issue with that is Suboxone is just as addictive as opiates are. You are basically substituting illegal drug use with a high for legal drug use without a high. You're still dependant. The issue lies with doctors not understanding how to get people off the drugs.

I understand the importance of pain killing, but opiates are the devil in disguise they are incredibly addictive. It's not just mental, which is the biggest issue for users. The withdrawals opiate users go through when they stop taking it can put down the strongest of people. There's a reason this is a huge problem in America. We need an alternative.

Oh and guess the number one place for poppy? Afghanistan. Interesting how we're at war there.

 

[chiefwiggum]

Here in Houston we have had a huge problem with the pain clinics/pill mills - while Tampa was the main hub for oxycontin prescriptions, Houston mirrored it with tons of pain clinics prescribing hydrocodone, carisoprodol (soma), and xanax. It was to the point where you could go to two, three clinics a day and be prescribed 120 lorcets, 90 soma, and 60 xanax as long as you had the money for the office visit and prescription. In the past few years they've
Well the Suboxone route gives you a normal lifestyle.as with the opiates it's never enough which makes the user do anything to get them. Which leads to all sorts of trouble. Financial, freedom and family.

The difference between a man addicted to opiates and Suboxone are not even in the same realm .
And you slowly ween off of them.

Anyone with a severe opiate problem this is your best option.

If you've done an opiate for a year or so that may be a different story.

@jgarner I meant to quote

 

[Gutter Chris]

There is no opiate epidemic. Its a fake media scare to keep the war on drugs going because our politicians and cops know the jig is up.

If you think opiates are some kinda scurge that needs to be stamped out you probably dont want to know anything about alcohol or the american diet.


That said its impossible to make non addictive pain killers because they make your brain release chemicals that feel good and your body is made to like that. Do it enough and its damn hard to stop doin because it feels awful to stop because your body gets used to a different chemistry.

 

[Gutter Chris]

I understand the importance of pain killing, but opiates are the devil in disguise they are incredibly addictive. It's not just mental, which is the biggest issue for users. The withdrawals opiate users go through when they stop taking it can put down the strongest of people. There's a reason this is a huge problem in America. We need an alternative.

The real issue is that americans are a banged up group of people with shitty healthcare. It will put you into deep debt to go on the table and get something fixed but it wont break the bank to fill a script. This is the real root cause of the problem and no one is taking about it.

 

[Thunderflash500]

Its like saying why can't they make fun not addicting. People evolved to do drugs. Its like a vitamin missing from modern life.

 

[FacePunch]

More important: Why can't we genetically engineer a dog that lives to be 80?

 

[squeezewax]

I've been addicted to Tramadol for years, it dominates my whole life!

 

[funcrusher2007]

Are you still having Norco prescribed?

Yes..there pretty easily prescribed,dr often wants me to up dose but I dont

 

[Dr J]

The people talking about aspirin, ibuprofen, etc... I doubt have had to experience any type of significant chronic pain. Last year I began to develop some back issues while off work (due to another injury). I was flat out miserable with only those options available. When I finally got back to work, gained insurance, and was prescribed stronger painkillers... it was a life changer. I only took them at night, also. I could deal with it during the day with over the counter options, but just having the relief at the end of the day made a substantial difference.

There are always going to be cases where a particular medication works for particular individuals. The issue isn't that they don't work work at all--it is that they are overprescribed/improperly prescribed in the face of increasing number of harmful side effects/outcomes. Patients coming in complaining of severe pain are often prescribed opioids because they are the strongest meds available--often by family practitioners who have received little training in residency in chronic pain management. Opioids aren't shown to be the best option for most acute pain management, though and there are plenty of studies showing they're not that great with chronic pain management, either. Some have shown no benefit of chronic therapy, while others have shown that functional outcomes are actually worse, with others linking opioids as a first line treatment lead to increased numbers of surgeries.

So yes, while there is anecdotal evidence of opioid therapy being beneficial for acute and chronic pain, the majority of literature doesn't support it. When you add that to increased number of addictions and overdose deaths, you can see that there is a good reason providers are hesitant to prescribe them.

 

[Dr J]

Its like saying why can't they make fun not addicting. People evolved to do drugs. Its like a vitamin missing from modern life.

I could be wrong, but I'm under the assumption that the question is why can't they create a medication as "effective" as opioids without the addiction.

While opioids definitely have a psychological component of addiction, this generally happens for abusers. People in legitimate pain don't experience the euphoria that abusers are seeking but still become chemically dependent at prescribed doses.

 

[Dr J]

?

Nothing like a little yoga to ease the post-surgery pain of ha ing you bones drilled.

As weird as it sounds, yes. Back pain, for the most part is a dynamic problem--that is, certain positions exacerbate pain, and others alleviate it. Strengthening specific muscles to improve posture and positioning and increasing flexibility is an effective way to improve pain and function.

Physical therapy is one of the first line options for most musculoskeletal pain issues. Patients aren't the most compliant with home exercise plans given to them by therapists, though. It can also be costly, and multiple visits are not covered by Medicaid.

 

[feedmelies]

There are always going to be cases where a particular medication works for particular individuals. The issue isn't that they don't work work at all--it is that they are overprescribed/improperly prescribed in the face of increasing number of harmful side effects/outcomes. Patients coming in complaining of severe pain are often prescribed opioids because they are the strongest meds available--often by family practitioners who have received little training in residency in chronic pain management. Opioids aren't shown to be the best option for most acute pain management, though and there are plenty of studies showing they're not that great with chronic pain management, either. Some have shown no benefit of chronic therapy, while others have shown that functional outcomes are actually worse, with others linking opioids as a first line treatment lead to increased numbers of surgeries.

So yes, while there is anecdotal evidence of opioid therapy being beneficial for acute and chronic pain, the majority of literature doesn't support it. When you add that to increased number of addictions and overdose deaths, you can see that there is a good reason providers are hesitant to prescribe them.

I find that very curious given my personal experience, and the experiences of family members. Since you made a summary statement on what the literature currency supports, can you provide meta-analyses that back it up? I have seen some research out there that says NSAID's and acetaminophen in combination can provide relief similar to opiods, but I haven't seen anything that approaches an overall conclusion that opiods aren't the best option and often lead to worse outcomes.

 

[feedmelies]

As weird as it sounds, yes. Back pain, for the most part is a dynamic problem--that is, certain positions exacerbate pain, and others alleviate it. Strengthening specific muscles to improve posture and positioning and increasing flexibility is an effective way to improve pain and function.

Physical therapy is one of the first line options for most musculoskeletal pain issues. Patients aren't the most compliant with home exercise plans given to them by therapists, though. It can also be costly, and multiple visits are not covered by Medicaid.

I have developed profound respect for PT's after having received therapy for a couple issues.