CAN LONG TERM USE OF OPIOIDS CAUSE RESPIRATORY PROBLEMS AND IS IT TIME FOR A CHANGE…

Can long term use of opioids cause respiratory problems and is it time for a change?

The straight answer is ‘yes’, according to Desert Home Treatment who say that ‘ The long-term effects of opioids on the bowels are significant, but it is the damage they do to the respiratory system that is behind most of the overdoses and fatalities that are related to opioid use. As opioids depress the central nervous system, they directly interfere with the body’s breathing mechanisms.’

Science Daily pointed out that ‘ Opioids are highly effective at killing pain, but they can also kill people by depressing their breathing and at the same time sedating them so that it can be impossible for them to wake up from oxygen deprivation,” says Richard Horner, a professor in the departments of Medicine and Physiology.’

Most pain killers opioids or otherwise can cause side effects but they tend to improve shortly after starting the treatment or following an intended dose increase. The most common side effect being constipation and itching but a respiratory problem is feared by many. They say it is mostly a concern in acute pain management where patients have not developed tolerance.

So should we be right to be sceptical about taking opioids for long term pain when they keep appearing in the news as sceptical ? Drug Abuse has written a great article on a ‘Need for Change’ with a list of 10 opiate alternatives. They include –

Over-the-Counter Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Cortiosteroids

Serotonin and Norephinephrine

Reuptake Inhibitors

Neurostimulators

Anticonvulsants

Injections

Physical Therapy Massage, Acupuncture and Chiropractic Care

Exercise

It’s certainly something to ponder about.

 

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OPIOID PAINKILLERS CRISIS THE SILENT EPIDEMIC ON THE ITV ‘TONIGHT’ PROGRAM…

 

On ITV Tonight Britain on Painkillers: The Silent Epidemic.

A quarter of a million people are struggling with opioids in the UK. There are many risks involved with taking them for long-term use. They say they are of no use for long-term pain and they think that exercise, meditation and tai chi are a good option or soothing alternative to get through your pain.

Over the past decade in Britain, prescriptions for these drugs have gone through the roof – up 80% in England alone. We’re now among the biggest consumers of opioids in Europe.

And the tragedy and irony is that while the drugs are super-effective for acute emergency pain, in 90% of long-term chronic pain cases, they don’t even work.

Pain specialists are also trying to get to grips with the fact we’ve practically sleepwalked into a public health crisis: GPs under pressure to help their patients deal with pain and patients sometimes too in distress to find other strategies rather than popping the pills.

According to the British Pain Society, approximately 8 million adults in the UK  report chronic pain that is moderate to severely disabling[1]. Back pain alone accounts for 40% of sickness absence in the NHS[2] and overall it costs £10 billion for the UK economy[3].  The UK has some of the best pain services in the world and the multidisciplinary British Pain Society is at the forefront of informing the public and professionals of what is available.

However, the British Pain Society believes more research is essential to allow pain services to offer the latest effective and safest treatments.  Unfortunately, pain research is not a priority for major UK funders.

So how have we got here and how do we step back from the brink?

Is it time to radically rethink how we manage pain?

I’ve been on Tramadol for over 15 years so a rethink of how I can cope with my pain would be amazing.

THE HIGHER LEVEL OF OPIOID TAKEN BEFORE SPINAL SURGERY CAN EFFECT THE SUCCESS OF YOUR SURGERY…

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According to an article in Medical News Today A new study appearing in the Journal of Bone and Joint Surgery (JBJS) links the use of opioid pain relievers to less improvement and higher levels of dissatisfaction following spine surgery.

Between 1999 and 2010, a greater focus on pain management resulted in a four-fold increase in opioids sold to hospitals, pharmacies and doctors’ offices, and a related and ongoing increase in opioid-related complications, including opioid dependence, impaired cognition and poor treatment outcomes. Previous studies have found a link between opioid use and diminished spine surgery outcomes; however, the studies did not account for differences in opioid consumption among patients.

Patients reported –
Increased preoperative opioid use was a significant predictor of worse health outcomes at 3 and 12 months following surgical treatment, as measured in 12-Item Short-Form Health Survey (SF-12) and EuroQol-5D (EQ-5D) scores.

Every 10 milligram increase in the daily morphine equivalent amount taken preoperatively was associated with a decrease in mental and physical health and disability scores: a .03 decrease in the SF-12 physical and mental health summary scores, a .01 decrease in the EQ-5D score, and a .5 increase in the Oswestry Disability Index assessment.

Opioid consumption seems to occur frequently in those with psychiatric comorbidities such as depression and anxiety, which may lead to increased opioid use.

“We have demonstrated that increasing amounts of preoperative opioid consumption may have a harmful effect on patient reported outcomes in those undergoing spinal surgery,” said lead study author Clinton J. Devin, MD, assistant professor of orthopaedic surgery and neurosurgery at the Vanderbilt Spine Center.

“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery,” said Dr. Devin.

Hmmm a very interesting read. It is a worry if you have to have any type of surgery not necessarily spinal surgery if you are already on opioids before the surgery takes place.

CUTTING DOWN ON MEDICATION…

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I’d read on a few forums that it can be quite hard to come off opioids but I was still determined to cut my quantity down by at least half.

The first side effect I had was the shakes, which I knew was nothing to worry about and would settle down.

Then came the pains from places I’d not had pain from before, in particular in my right foot which is still giving me a lot of problem.

Then the headaches which seem to always arrive in the middle of the night, but I’ve found doing the acupressure points or using the roller ball works for this.

Lastly (at least I hope so) has come the ‘chronic fatigue’, which is nothing like I normally suffer from, but ten times worse. All I want to do is sleep, from the minute I wake up, I just want to go back to sleep again. By late morning I can’t wait for the afternoon to come so I can go for my rest which has now extended to two hours instead of my usual one.

I can only presume it’s my bodies way of trying to manage the pain on it’s own without the help of the opioids which I have cut down from 450mg to 100mg so that is a massive drop. However, I have had the odd 50mg when I’ve been desperate but I’ve managed on paracetamol most of the time.

It’s only 10 days so it’s early days yet but I’m really pleased with my progress except for the chronic fatigue which I really do hope will lift soon.

If you suffer from chronic fatigue, how do you cope with it?