“Chasing” pain

chronic-pain-managementAbout 15 years ago, a physician friend discussed the difference between pain and suffering, and the different responses to each.

This article makes me wonder how often we fail to address suffering and focus exclusively on treating pain. That may make sense with acute pain, but addressing suffering seems to be an essential element of addressing chronic pain.

Today, most doctors remain focused on treating physical pain, which is just one symptom of chronic pain, experts say. And as a result, they also often “chase” pain, increasing opioid dosages as lower amounts become ineffective, exposing patients to more side effects.

“It becomes a vicious cycle,” said Roger Fillingim, a pain researcher at the University of Florida and a past president of the American Pain Society, a professional medical group.

A 2008 study by the Mayo Clinic found that patients who were weaned off opioids and put through a non-drug-based program experienced less pain than while on opioids and also significantly improved in function. Other studies have had similar findings.

UPDATE: Some recent posts have pointed out the lack of evidence for the use of opiates for long term management of chronic pain.

Mind Over Matter: Beating Pain and Painkillers

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Findings were recently published on a study of a mindfulness based intervention for chronic pain and opioid misuse.

To test the treatment, 115 chronic pain patients were randomly assigned to eight weeks of either MORE or conventional support group therapy, and outcomes were measured through questionnaires at pre- and post-treatment, and again at a three-month follow-up. Nearly three-quarters of the group misused opioid painkillers before starting the program by taking higher doses than prescribed, using opioids to alleviate stress and anxiety or another method of unauthorized self-medication with opioids.

Among the skills taught by MORE were a daily 15-minute mindfulness practice

“People who are in chronic pain need relief, and opioids are medically appropriate for many individuals,” Garland said. “However, a new option is needed because existing treatments may not adequately alleviate pain while avoiding the problems that stem from chronic opioid use.”session guided by a CD and three minutes of mindful breathing prior to taking opioid medication. This practice was intended to increase awareness of opioid craving—helping participants clarify whether opioid use was driven by urges versus a legitimate need for pain relief.

It’s important to note that this may be a very useful option for non-addicted opioid misusers with chronic pain.

They are also trying the model for smoking cessation. It’ll be interesting to see their outcomes.

It’ll also be interesting to see if more non-pharmacological treatments for pain, either as adjuncts to medication or as stand-alone treatments. Facing chronic pain is a concern for most recovering people I know, especially recovering opiate addicts.

 

via Mind Over Matter: Beating Pain and Painkillers | University of Utah News.

Buprenorphine compliance rates

Choose you evidence carefully by rocket ship
Choose you evidence carefully by rocket ship

The following abstract popped up today.

The purpose of the study was to look at factors associated with completion of the 6 month, primary care based program.

What struck me was the completion rate–35.7%. For all the crowing about ORT, this seems really low. (And, they said this completion rate is consistent with prior studies.) This is particularly underwhelming when the researchers identify physical injury as a predictor of completions and speculate that this is related to chronic pain. These subjects constitute 71.7% of completers. So…when you omit those with injuries, the completion rate drops to 24%.

Primary care patient characteristics associated with completion of 6-month buprenorphine treatment

BACKGROUND: Opioid addiction is prevalent in the United States. Detoxification followed by behavioral counseling (abstinence-only approach) leads to relapse to opioids in most patients. An alternative approach is substitution therapy with the partial opioid receptor agonist buprenorphine, which is used for opioid maintenance in the primary care setting. This study investigated the patient characteristics associated with completion of 6-month buprenorphine/naloxone treatment in an ambulatory primary care office.
METHODS: A retrospective chart review of 356 patients who received buprenorphine for treatment of opioid addiction was conducted. Patient characteristics were compared among completers and non-completers of 6-month buprenorphine treatment.
RESULTS: Of the 356 patients, 127 (35.7%) completed 6-month buprenorphine treatment. Completion of treatment was associated with counseling attendance and having had a past injury.
CONCLUSIONS: Future research needs to investigate the factors associated with counseling that influenced this improved outcome. Patients with a past injury might suffer from chronic pain, suggesting that buprenorphine might produce analgesia in addition to improving addiction outcome in these patients, rendering them more likely to complete 6-month buprenorphine treatment. Further research is required to test this hypothesis. Combination of behavioral and medical treatment needs to be investigated for primary care patients with opioid addiction and chronic pain.