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pangstrom posted:CDC released some guidelines, which I haven't read yet, but from the article gist they sound reasonable to me. For other opinions you can see the comments! If these guidelines become standard of care it will be bad new for chronic pain patients in the United States. Opioids should be an option for all chronic pain patients. There are definite risks and the long-term outcomes in terms of pain and function are likely minimal but a reasonable patient could conclude that the immediate pain relief outweighs the harms. Guidelines like these take the decision out of the hands of patients, and go so far to treat pain patients in a punitive/adversarial fashion. Some particular complaints of mine are that the guideline authors downplay the risks associated with nonopioid pharmacologic treatment(ex: cardiovascular and gastrointesinal risks of NSAIDs described as " nonopioid therapies ... are also associated with short-term benefits, and risks are much lower") and overstate the effectiveness of nonpharmacologic treatment(ex: Cognitive bias therapy and exercise) in chronic pain disorders. Categorical statements like "Opioids should not be considered first-line or routine therapy for chronic pain outside of active cancer, palliative, and end-of-life care" are especially egregious. Furthermore, the authors include measures that could be seen as punitive such as regular urine screening for all long-term opioid users despite a complete and utter lack of evidence of efficacy(the only non-grade A recommendation included and based primarily on "clinical experience and observation"). The analysis and presentation of evidence seem to try to justify a politically popular "crackdown" on opioid use rather than an objective summary of available evidence.
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Mar 16, 2016 13:09
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Rhandhali posted:That's not why the add acetaminophen to codeine or other opiates. Dying of acute liver failure from Tylenol OD is ugly. Real ugly, and expensive. Like days to weeks of ICU and slow decline plus or minus a liver transplant and a lifetime of followup and immunosuppression. From a regulatory standpoint, acetaminophen is absolutely added to opiates as a poison. There are clear downsides to combination products(unable to change doses for example, is it ideal that a patient would have to supplement with OTC tylenol if they decide to reduce their opiate dose) as opposed to taking two separate pills. The regulators obviously don't intend for patients to overdose on acetaminophen but rather want patients to recognize acetaminophen toxicity and refrain from any increased use of the combination product.
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Apr 27, 2016 03:07
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moller posted:Although assuming for profit healthcare the former is much more lucrative than the latter. Formulation decisions regarding controlled substances are often driven by scheduling concerns. A component of the formulation of Acetaminophen/Opiate combination products was a desire to avoid a Schedule II classification(although this point is now moot and the combination products exist mostly due to regulatory inertia). From the Controlled Substances Act Section 811 (g): Controlled Substances Act posted:(3) The Attorney General may, by regulation, exempt any compound, mixture, or preparation containing a controlled substance from the application of all or any part of this subchapter if he finds such compound, mixture, or preparation meets the requirements of one of the following categories:
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Apr 27, 2016 07:07
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Rhandhali posted:The American Pain Society, which does receive large amounts of pharmaceutical industry funding, came up with the "fifth vital sign" bullshit. Not coincidentally they started pushing it hard around the time OxyContin came to market. By 2001 the joint commission made sure it was forced down everyone's throats. This is an unreasonable standard to hold the American Pain Society to. Nearly all treatment guidelines are written by societies/groups funded by device manufacturers and the pharmaceutical industry. If anything they are kept at further length by pain societies in order to avoid the appearence of impropriety. The reason that joint commision guidelines caused such consternation in the medical community is that it moved the locus of control towards the patient from the traditional paternalistic roots of medicine. It did not prescribe treatments of pain, merely required that pain be monitored and that patients be given the option to manage their pain. The simple fact that patients being given autonomy over their pain control is so controversial is a damning indictment of the medical community as a whole.
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Mar 29, 2018 06:15
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