Why can't we make nonaddictive painkilllers?

[DoomPatrol]

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.

There's no way that NSAIDs and acetaminophen combined are going to give a patient the same level of pain relief as IV fentanyl or morphine.

 

[Dr J]

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.

Most meta-analysis I've seen show that opioids prove better than placebo but are inconclusive in other comparison studies. The things I've mentioned were mostly seen individual studies and systematic reviews. A study looking at patients in the SPORT trial, for example, looked at outcomes for patients who were started on opioids vs those who didn't and showed higher surgical crossover in patients who were taking opioids.

As far as not being the best option, I've generally seen that radiculopathies/neuropathic pain responds better to meds like gabapentin, Lyrica, and Elavil. I can't point you to a particular study off hand, but it's been somewhat of a standard in the practices in which I've worked. In personal experience, I will usually start with an NSAID, steroid taper, or a gabapentin/Lyrica based on medical history and in some cases a short course of as needed opioids for breakthrough pain.

In issues such as OA/joint pain, opioids aren't generally seen as first line drugs, and I haven't seen any data suggesting that they are more effective in terms of functional gains, and the risks of adverse side effects are higher.

Regardless, a lack of evidence doesn't mean that something isn't effective. On top of that, I remain hesitant of studies involving pain scales, as I've treated people in acute sickle cell crisis screaming bloody murder in 10/10 pain and others who are smiling when they tell you they're in a 10/10 pain. Subjective scoring systems are deceiving, and I prefer functional outcome measures. I think opioids do show effectiveness in managing pain, and with careful screening and proper prescription, the addiction issue can be minimized.

 

[helltoupee]

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.

And how many of these studies were funded, either directly or indirectly, by pharmaceutical companies looking to unleash the newest bestest non-addictive, non-opioid painkiller?

I'd like to see any the authors of your pubmed studies nurse a broken tibia with anything BUT an opioid.

Second, many of the medications they prescribe you in lieu of opioids have just as many side effects, and/or are just as damaging, if not worse, but hey, at least they don't give *some* people a buzz!

 

[Dr J]

There's no way that NSAIDs and acetaminophen combined are going to give a patient the same level of pain relief as IV fentanyl or morphine.

I have seen some research out there that says NSAID's and acetaminophen in combination can provide relief similar to opiods

Of course, but physicians aren't sending people home on IV opioids.

To speak to what Feedmeiles stated, threre was a Cochran Review that looked at kidney stones being treated with NSAIDs vs oral opioids. Both were found to be effective, and though lower scores were noted in the NSAID studies.

Interestingly, a colleague of mine was hospitalized with a tooth absences that caused him to become septic. He was in an absurd amount of pain, and they were hitting him up with IV Dilaudid, which he didn't feel touched the pain. He got his best relief from IV Tordol.

 

[Dr J]

And how many of these studies were funded, either directly or indirectly, by pharmaceutical companies looking to unleash the newest bestest non-addictive, non-opioid painkiller?

I'd like to see any the authors of your pubmed studies nurse a broken tibia with anything BUT an opioid.

Second, many of the medications they prescribe you in lieu of opioids have just as many side effects, and/or are just as damaging, if not worse, but hey, at least they don't give *some* people a buzz!

Someone coming into the hospital with a bad tibia break is likely getting IV pain meds from the get go, and post operatively, as well. No one is saying there is no use for opioids in managing pain.

I'd be happy to link you to authors of studies if you are interested in finding out where finding is coming from, but I don't think it's the case. Studies aren't showing that opioids don't have analgesic properties--it's obvious that they do. The issue is long term efficacy of managing non-cancer related pain into questions, with most studies I've seen showing to be inconclusive, not ineffective. As far as sources like Cochrane is concerned, there have been criticisms of their publications; but they are reviews of multiple studies published by other people, not an individual study looking to prove a point.

I completely agree that there are horrible side effects when it comes to medications like NSAIDs and acetaminophen, and no doubt physicians are/need to be wary of medical histories and require monitoring. Let's not pretend people getting a buzz is the issue with opioids, though.

 

[cincymma79]

There is such a drug
It's called stop being a goddamn fucking pussy

 

[Pale Man In Black]

I always tell my son that pain is weakness leaving your body.
Anyway, the cynic in me says the answer is: $$$$$$$$$$$$$$$$$$$
Keep 'em coming back for more.

 

[rearnakedchoke]

No money in that shit.