Opioid Narcotic Medications For Chronic Pain

For the past 25 years, doctors have been told to treat the underappreciated epidemic of chronic pain in our country. The main hospital certification agency and others have promoted pain rating scales as the “5th vital sign”, added onto the traditional blood pressure, temperature, heart rate and respiratory rate. Physicians and hospitals responded and we saw a surge in prescriptions for controlled opioid narcotic pain pills.

What did we discover? Opioids for acute pain (trauma, surgery, etc…) are readily justified by multiple studies. Yet, the evidence of benefit for opioids in chronic pain is very limited at best, and the risks are clear.

Recent published studies repeatedly show the scant benefits and very strong harms of opioids in chronic pain. In the past few weeks, a study in JAMA showed “Long-Acting Opioids Tied to Increased Mortality Unrelated to Overdose”.  http://goo.gl/IqL9ne Compared to patients treated with non-opioid chronic pain meds (like gabapentin or amitriptyline), those using opioids for chronic pain had a 72% increased risk for death from causes other than unintentional overdose.  http://archinte.jamanetwork.com/article.aspx?articleid=2522397 We already know unintentional (and intentional) overdose deaths are increased for those receiving chronic opioids for pain.

In Idaho in 2012, appx 90 opioid prescriptions were written for every 100 adults.http://www.cdc.gov/drugoverdose/data/prescribing.html

Maybe it would be worth the higher death rate if opioids were amazing medications for chronic pain. They are not. A meta-study combining 20 controlled trials showed opioid analgesics provide modest short-term pain relief, BUT the effect is not likely to be clinically important within guideline recommended doses. And most importantly, evidence on long-term benefits for chronic low back pain is lacking. http://jama.jamanetwork.com/article.aspx?articleid=2528212

Bottom line, chronic opioids are poor medications for chronic pain (including low back pain) and they increase the death rates for not only overdose but ALL cause mortality, including cardiovascular death (heart attacks).

CDC guidelines – http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

ASAM- http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

Blue Light Blocking Orange Glasses For Bipolar Mania

First randomized trial of blue light blocking glasses (orange tinted shades) for acute bipolar mania treatment showed they were highly effective as an add-on treatment for patients in a manic episode, with a significant difference seen as early as three days after the start of the intervention.

http://onlinelibrary.wiley.com/enhanced/doi/10.1111/bdi.12390https://www.lowbluelights.com/products.asp?PageIndex=9

This is exciting but early research. Since the downside is negligible compared to antipsychotic or lithium meds, this is a potential game changer, IF additional trials can confirm the findings. These glasses are already being used for 1-3 hours prior to bedtime for insomnia treatment by regulating melatonin. The current protocol included wear from 6 pm – 8 am (except while sleeping).

The mechanism underlying the effects of blue blocking glasses in mania need further investigation, but current focus is that the anti-manic effect seen during treatment is due to silencing of signalling in the ipRGC circuits directly influencing mood and cognition, rather than indirect effects via melatonin secretion, sleep or increased circadian synchrony.

Probiotics In Acute Diarrhea 1wk Is Not Recommended

The American College of Gastroenterology has released new guidelines for the evaluation and treatment of acute diarrhea and travelers’s diarrhea. http://goo.gl/bAswnG

While most of the recommendations are directed to physicians, one point stands out to patients: prebiotics or probiotics are NOT recommended, unless the diarrhea is caused by antibiotics upsetting the normal gut flora (bacteria that usually live in the intestines). Most times , one can adequately rehydrate with water, juice such as dilute apple juice, sports drinks, soups, and salty crackers.

Should you make an appt? See your physician if you have:

  • bloody diarrhea,
  • severe diarrhea disease not responding to 2-3 days of OTC treatment [such as  loperamide, bismuth, immodium, pepto bismol],
  • dehydration (no urine output > 8 hrs),
  • symptom duration >7 days.

ADHD Meds Lower Risk For Teen Substance Abuse

 A common concern among caring parents is that treatment for ADHD with stimulant medication such as methylphenidate (Ritalin, Concerta) or dextroamphetamine (Adderall) will lead to addiction and substance abuse in the teen years. http://www.currentpsychiatry.com/home/article/do-stimulants-for-adhd-increase-the-risk-of-substance-use-disorders/aeff7b1bc2f03475bfdad4cd7e0fd91d.html

While this is a valid question, the evidence based answer clearly is “no”, stimulants do NOT lead to substance abuse. Multiple studies over the years continue to demonstrate the stimulants substantially lower the risk for substance abuse. http://www.ncbi.nlm.nih.gov/pubmed/14529324.  http://www.jaacap.com/article/S0890-8567(16)30099-5/abstract.

In fact, UNTREATED ADHD children have higher risk for substance abuse than peers in the same age group; treatment with stimulants reduces the risk for kids with ADHD back to the rate seen in the general population.

Bottom line, if you and your doctor decide to treat ADHD with stimulant meds, you do not need to worry you are putting them at risk for later substance abuse or addiction.