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Thread: Oral Opioids Control Pain

  1. #1

    Oral Opioids Control Pain

    Reported March 27, 2003

    Oral Opioids Control Pain

    SAN FRANCISCO (Ivanhoe Newswire) -- High doses of a strong type of pain reliever can minimize neuropathic pain, say researchers publishing in this week's New England Journal of Medicine. However, the treatment often comes at a price.

    According to the study, patients who received 0.75 milligrams doses of the opioid levorphanol reported a reduction in pain of 36 percent, compared with 21 percent for those who took the 0.15 milligrams dose. Side effects were much more common in the high dose group, however, leading some patients to stop the study before it was completed.

    Treatment of chronic neuropathic pain, such as that arising from stroke, multiple sclerosis, or spinal cord injury, has been difficult for doctors to manage. Some studies have shown opioids can be effective in this group of patients. Others suggest the drugs cause too many side effects or patients soon build up too much tolerance to the drugs.

    In this study, investigators assigned 81 patients to receive either the high dose or low dose pills. All were allowed to take up to 21 pills per day, depending on their individual needs.

    Results show patients taking the high dose pills had better pain relief with fewer numbers of pills. On average, they took 11.9 capsules per day, compared with 18.3 for those in the low dose group.

    However, the advantages of the high dose pills were limited to pain reduction, and 12 patients in the high dose group dropped out because of side effects. Only three patients in the low dose group dropped out.

    The authors conclude, "Higher doses of the opioid levorphanol are more effective than low doses in reducing the intensity of chronic neuropathic pain ... but in many patients, pain relief is not achieved or there are intolerable side effects."


    SOURCE: New England Journal of Medicine, 2003;348:1223-1228

    http://www.ivanhoe.com/channels/p_ch...m?storyid=5759

  2. #2
    Senior Member alan's Avatar
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    I could have told them about having to stop opiates due to side effects.

  3. #3
    Alan there is a lot you could tell people about and I enjoy reading when you post!!
    Thank you,

    Mary

    ...and she lived happily ever after...

  4. #4
    Banned Acid's Avatar
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    Ain't that the stuff

    that makes addicted, and messes into own receptor molecule balances
    for relevant emotional levels, and not "just" that?

    Acid


    P.S.: Kept finding it remarkable, when main effects
    were parked off as "side" effects.

  5. #5
    Senior Member Max's Avatar
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    Opioids Effective Against Neuropathic Pain

    Opioids Effective Against Neuropathic Pain
    Wed Mar 26,11:46 PM ET Add Health - HealthScoutNews to My Yahoo!


    By Amanda Gardner
    HealthScoutNews Reporter

    WEDNESDAY, March 26 (HealthScoutNews) -- Opioid medications, long stigmatized by patients and physicians alike, may now be poised for greater acceptance in the field of pain management.


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    A study appearing in the March 27 issue of The New England Journal of Medicine (news - web sites) found that higher doses of the morphine-like medication levorphanol reduced neuropathic pain significantly more than lower doses of the same medicine.


    A second study, this one appearing in the March 25 issue of Neurology, found that another opioid, OxyContin, decreased pain and improved sleep quality for people with diabetic neuropathy.


    Neuropathic pain emanates from injury to the central or peripheral nerves and affects more than 2 million Americans. There are no clear guidelines on how to treat the condition, and many available drugs have had disappointing results, writes Dr. Kathleen M. Foley in an editorial accompanying The New England Journal of Medicine study.


    Three broad categories of drugs are available to treat neuropathic pain, explains Dr. Russell K. Portenoy, lead author of the Neurology article and chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City. They are opioids, non-opioids and adjuvant analgesics, which are drugs that are for something else (for example, local anesthetics and antidepressants) but have been shown to work against pain.


    Among those three groups, opioids have been the most controversial. "The positioning of opioid therapy for patients for chronic pain of all types, not just neuropathic, is evolving very quickly," Portenoy says. "Fifteen years ago, opioids were considered to be inappropriate for most patients with chronic pain. Now, in 2003, we have consensus statements from many medical societies that say opioids should be considered."


    One reason for opioids' position on the margins of medicine is, of course, their association with addiction. They are classified as narcotics and are regulated by the Drug Enforcement Administration, which in itself is enough to make some doctors squeamish. There have also been issues regarding side effects and a perception that patients would develop a tolerance to the drugs, causing them to be ineffective, Portenoy says.


    Another reason is that about a decade ago, some studies indicated that opioids were ineffective against nerve pain. "That controversy stood in contrast to a lot of clinical observation," Portenoy says.


    Fast forward to 2003 and The New England Journal of Medicine article. In this study, 81 adults with neuropathic pain were randomly assigned to receive either high-strength (0.75 milligrams) or low-strength (0.15 milligrams) capsules of levorphanol for eight weeks.


    The study authors picked the lesser known drug levorphanol over high-profile drugs such as methadone or morphine precisely because they wanted to bypass as much as possible any preconceived notions. Although the consent form clearly stated this was an opioid, the researchers felt levorphanol didn't have the same stigma.


    Participants could regulate their own doses within certain limits so as to achieve the best balance between pain relief and side effects.


    The high-strength capsules reduced pain by 36 percent, whereas the low-strength dosage reduced pain by 21 percent. These results are comparable to the effects of tricyclic antidepressants and the anticonvulsant gabapentin, both of which are commonly used to treat pain.


    On average, patients in the high-strength group took 11.9 capsules per day while patients in the low-strength group took 18.3 a day, which was close to the 21-a-day upper limit allowed. Functioning and sleep were improved in both groups. And even though the trial lasted only eight weeks, participants did not seem more likely to escalate their dose by the end of the study, indicating that they were not developing a tolerance to the drug.


    "Our study shows that [the drugs] clearly are effective," says study author Dr. Michael Rowbotham, a professor of clinical neurology and anesthesia at the University of California, San Francisco, and director of the school's Pain Clinical Research Center. "The higher-dose levels were more effective at relieving pain than the lower-dose levels, but it carried a price in terms of side effects."


    Before the study ended, 59 patients (27 percent) withdrew, mostly because of various side effects, and more people dropped out in the high-dose group. The side effects of irritability and personality changes occurred only in the higher-strength arm of the study.


    Certain types of pain disorders were also easier to treat than others. Only three out of 10 patients with brain injury-related pain (such as stroke) were able to complete the study. Individuals with pain from spinal cord injury or multiple sclerosis seemed to benefit greatly from the high-dose capsules.


    Even though the drug didn't help everyone, it helped enough to earn it a place in the arsenal of pain medications, the authors state.





    "The fundamental thing that was shown in these studies is that opioids can work for neuropathic pain. You can get adequate pain relief and you can do that without intolerable toxicities," Portenoy reports. "All of these controlled trials are creating a very strong evidence base that is refuting the perspective that neuropathic pain is unresponsive to opioids. It's very reasonable for doctors to now think about trying opioids."

    More information

    For more on the use of opioids in pain management, visit the American Pain Society or the American Academy of Pain Medicine.



    http://story.news.yahoo.com/news?tmp...uropathic_pain

  6. #6
    Once again, Acid nailed it.

    We bury my friend the hydrocodone victim tomorrow.

    We can bomb stuff UNDER a bridge-why can't there be treatment for pain that isn't addictive and tolerance building?

  7. #7
    Senior Member Max's Avatar
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    Opioids: a pain solution?

    Opioids: a pain solution?
    March ,
    Opioid medications, long stigmatised by patients and physicians alike, may now be poised for greater acceptance in the field of pain management.
    A study appearing in the March 27 issue of The New England Journal of Medicine found that higher doses of the morphine-like medication reduced neuropathic pain significantly more than lower doses of the same medicine.

    A second study, this one appearing in the March 25 issue of Neurology, found that another opioid decreased pain and improved sleep quality for people with diabetic neuropathy.

    Neuropathic pain emanates from injury to the central or peripheral nerves and affects thousands of South Africans. There are no clear guidelines on how to treat the condition, and many available drugs have had disappointing results, writes Dr Kathleen Foley in an editorial accompanying The New England Journal of Medicine study.

    Categories of pain drugs
    Three broad categories of drugs are available to treat neuropathic pain, explains Dr Russell Portenoy, lead author of the Neurology article and chairman of the department of pain medicine and palliative care at Beth Israel Medical Centre in New York City, USA. They are opioids, non-opioids and adjuvant analgesics, which are drugs that are for something else (for example, local anaesthetics and antidepressants) but have been shown to work against pain.

    Among those three groups, opioids have been the most controversial. "The positioning of opioid therapy for patients for chronic pain of all types, not just neuropathic, is evolving very quickly," Portenoy says.

    "Fifteen years ago, opioids were considered to be inappropriate for most patients with chronic pain. Now, in 2003, we have consensus statements from many medical societies that say opioids should be considered."

    Questions of addiction and efficacy
    One reason for opioids' position on the margins of medicine is, of course, their association with addiction. They are classified as narcotics and are strictly regulated. There have also been issues regarding side effects and a perception that patients would develop a tolerance to the drugs, causing them to be ineffective, Portenoy says.

    Another reason is that about a decade ago, some studies indicated that opioids were ineffective against nerve pain. "That controversy stood in contrast to a lot of clinical observation," Portenoy says.

    The recent study
    Fast-forward to 2003 and The New England Journal of Medicine article. In this study, 81 adults with neuropathic pain were randomly assigned to receive either high-strength (0,75 milligrams) or low-strength (0,15 milligrams) capsules of levorphanol for eight weeks.

    The study authors picked the lesser-known drug levorphanol over high-profile drugs such as methadone or morphine precisely because they wanted to bypass as much as possible any preconceived notions. Although the consent form clearly stated this was an opioid, the researchers felt levorphanol didn't have the same stigma.

    Participants could regulate their own doses within certain limits so as to achieve the best balance between pain relief and side effects.

    Pain significantly reduced
    The high-strength capsules reduced pain by 36 percent, whereas the low-strength dosage reduced pain by 21 percent. These results are comparable to the effects of tricyclic antidepressants and the anticonvulsant gabapentin, both of which are commonly used to treat pain.

    On average, patients in the high-strength group took 11,9 capsules per day while patients in the low-strength group took 18,3 a day, which was close to the 21-a-day upper limit allowed. Functioning and sleep were improved in both groups. And even though the trial lasted only eight weeks, participants did not seem more likely to escalate their dose by the end of the study, indicating that they were not developing a tolerance to the drug.

    Higher doses more effective
    "Our study shows that [the drugs] clearly are effective," says study author Dr Michael Rowbotham, a professor of clinical neurology and anaesthesia at the University of California, USA. "The higher-dose levels were more effective at relieving pain than the lower-dose levels, but it carried a price in terms of side effects."

    Before the study ended, 59 patients (27 percent) withdrew, mostly because of various side effects, and more people dropped out in the high-dose group. The side effects of irritability and personality changes occurred only in the higher-strength arm of the study.

    More effective in certain types of pain disorders
    Certain types of pain disorders were also easier to treat than others. Only three out of 10 patients with brain injury-related pain (such as stroke) were able to complete the study. Individuals with pain from spinal cord injury or multiple sclerosis seemed to benefit greatly from the high-dose capsules.

    Even though the drug didn't help everyone, it helped enough to earn it a place in the arsenal of pain medications, the authors state.

    "The fundamental thing that was shown in these studies is that opioids can work for neuropathic pain. You can get adequate pain relief and you can do that without intolerable toxicities," Portenoy reports. "All of these controlled trials are creating a very strong evidence base that is refuting the perspective that neuropathic pain is unresponsive to opioids. It's very reasonable for doctors to now think about trying opioids." - (HealthScout News)

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  8. #8
    Senior Member alan's Avatar
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    Actually, I'm asking my doctor if we can give levorphanol a try. I've got nothing to lose, except maybe enough edge off the pains that I can get my ass out of here. Maybe it will affect my body like dilaudid, which seems to stimulate my bladder and not block the other end badly.

    Something has to ease the cramped, burning, skinned, et al, feeling in my back and abdomen before I decide to go play in traffic. If it helps the hands and legs as well, that's a bonus, because those parts aren't my priority - they don't keep me homebound, keep me from eating, or limit my function.

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