Opioids Were Never Intended To Improve Function Just Relieve Pain

Today's post from clinicalpainadvisor.com (see link below) is an ever-so-subtle addition to the current media-inspired movement that claims all things 'opioid' are bad. It addresses opioids and neuropathic pain directly and comes to negative conclusions based on the study results that show that opioids produce little improvement in function in people who take them. However, opioids don't address the disease and are not meant to be 'cures'. Don't these people realise that opioids are never meant to improve function - they're meant to reduce pain and in that respect, they are very successful. Of course, reduced pain can enable people to function better but only because their pain is gone, not because the original illness has been addressed. Of course the media realise this full well! Inventing negative effects that were never claimed to be benefits of opioid use in the first place, is a sort of negative publicity that's used in politics all the time. The fact is that if you are taking opioids for neuropathic pain, you have tried everything else and nothing works, leaving you with opioids that generally do the job. Of course they have to be controlled and monitored and the patient has to take some responsibility to make sure that the potential for addiction is minimised but good doctors should be monitoring you to within an inch of your life to make sure you're not entering any sort of spiral. Opioids have been used for pain control since the dawn of time but like everything in this modern world, we always seem to need a sledgehammer to crack a nut!

How Effective Are Opioids in Neuropathic Pain? 
Steve Duffy January 26, 2016

Improved function may not necessarily follow opioid treatment.

A new study suggests that opioid prescriptions for patients with neuropathic pain, may not improve their physical function or disability. In fact, results from the study — conducted by the University of Alberta and published in Pain Medicine — indicate that opioid use could be harmful when it comes to physical recovery for patients with neuropathic pain.

"We studied patients with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves, and the ones who weren't prescribed any opioids had statistically lower disability and higher physical functioning scores," said Geoff Bostick, PhD, lead author of the study.

TRENDING ON CPA: ACA Supports Proposed Guideline for Prescribing Opioids to Patients With Chronic Pain

The study sample included 789 patients with neuropathic pain across Canada. Patients gave self-reported measures of physical function (pain disability index) and a medical outcomes study short form-12 physical function (PCSS-12), at the beginning of the study, then again at 6 months and 12 months after treatment began. Analysis of covariance models was created to examine the association between opioid therapy and both physical functioning outcomes with adjustment for confounding.

Results showed that patients prescribed opioid treatment did not report greater physical functioning or lower disability than patients who were not prescribed opioids — even after the results were adjusted for disease severity. The improvements in disability and physical functioning scores from baseline and 12 months for all groups were "modest and may not be clinically significant," authors reported.

They asserted that while opioids are a powerful painkiller, the results of the study testify that improved function does not necessarily follow opioid treatment.

In addition, they highlighted the association between opioid prescription and a patient's quality of life, considering that the treatment may not be aiding the patient's functionality. They call for further research to analyze this correlation.

For those who have chronic pain but are medically cleared for physical activity, a graded approach to recovery is suggested, according to Dr. Bostick. "I tell patients to walk until they are at 50% of their tolerance — walk and stop before the pain gets too bad. Each week, walking time is gradually increased. Over time, this tolerance will slowly increase and so will physical function."
Reference

Bostick G, Toth C, Carr E et al. Physical Functioning and Opioid use in Patients with Neuropathic Pain. Pain Med. 2015;16(7):1361-1368. doi:10.1111/pme.12702.
This article originally appeared on MPR.

http://www.clinicalpainadvisor.com/neuropathic-pain/how-effective-are-opioids-in-neuropathic-pain/article/467341/

A Neuropathic Pet Is Also For Life And Not Just For Christmas

Today's post from petmd.com (see link below) highlights a little-known fact that dogs, cats and other domestic mammals can also suffer from neuropathy. Now if you suffer from nerve damage, you can tell others how you're feeling but even then, it can be difficult describing your symptoms. Imagine then how long a dog or cat might be suffering before you notice something's wrong! They can't tell you and you can't question them! This article provides a list of symptoms to look out for, which is helpful. It's also pretty astonishing to learn that one of the common treatments is Gabapentin, which as you know is also prescribed for humans (with or without side effects). Spare a thought for your pets this festive season - they don't have special orthopedic footware as they walk through the mud and cold but you can imagine what they may be going through if they suffer from neuropathy. If you're concerned, a trip to the vet may be in order.

Neuropathic Pain in Dogs 
Pain from the Nervous System in Dogs

Neuropathic pain commonly results from an injury or disease relating to the body’s nerves and how they function, or within the spinal cord itself. This particular kind of pain is difficult to pinpoint, especially in patients that are unable to respond to specific inducements.

Symptoms and Types

Damage to the tissues of the body, and the nerves running through them, creates a constant (chronic) pain that is brought on by a light touch to the affected area and/or a heightened perception of pain. Pain originating within the spinal cord causes problems with mobility and various functions of the body.

Some of the symptoms of neuropathic pain may include:

Limping or dragging a limb
Shaking or twitching of the skin
Chewing on the affected area
Muscle wasting (atrophy)
Crying out (vocalizing)
Decreased appetite
Urinating and defecating inappropriately (incontinence)

Causes

Neuropathic pain may result from an injury to body tissues or a growth (tumor) in the spinal cord. Diseases that affect the spinal cord, such as intervertebral disc disease (IVDD), may cause pain in different areas of the body, depending on which part of the cord is affected. Another potential cause of neuropathic pain is amputation of a limb. Phantom limb pain results in the impression of pain coming from a leg that has been surgically removed.

Diagnosis

In general, neuropathic pain is diagnosed by ruling out other causes of pain and performing reflex tests to evaluate the nervous system. Basic blood tests can help rule out infectious and disease-related causes. X-rays and special imaging may be necessary to search for tumors in the bone or spinal cord. Finally, a good discussion of your dog's medical history and previous symptoms will help lead to the proper diagnosis.

Treatment
Analgesic medications (those that relieve pain) are used as the initial treatment for neuropathic pain. The amount given may need to be changed until the best effect is achieved. Other types of pain relievers may be tried until the one that works best for your dog is found. Some veterinarians may choose to use several pain medications at one time and then taper off until only one is being given.

One medication that has been used with success for long-term pain is gabapentin. This anti-seizure drug has analgesic properties that are particularly effective for reducing neuropathic pain in dogs. Gabapentin is given once daily for pain control and can be given with or without food. The particular side effects of this drug include sedation, weight gain and stumbling (ataxia). Diarrhea may also be seen in some animals.

Living and Management

Dogs with chronic pain may gain considerable relief from analgesic medications. The quality of life for these animals can be much improved, as long as the underlying condition causing the pain is under control.

In dogs with kidney problems, the dosage of gabapentin may be reduced, as the drug is processed through the kidneys and they must be functioning properly for the drug to be removed from the body. Animals that are pregnant should not be treated with gabapentin. When discontinuing the medication, gabapentin should be slowly tapered off to prevent seizures from occurring after long-term use.

http://www.petmd.com/dog/conditions/neurological/c_dg_neuropathic_pain