Opioids are not always helpful in treating fibromyalgia, chronic low back pain, or chronic headaches. A forum rises against the excessive prescription of these drugs.
Opioid prescriptions for chronic pain are sometimes unnecessary. In a column published in Neurology, the American Academy of Neurology takes a stand against the too systematic recourse to these drugs, the side effects of which are however heavy. Its author, Gary Franklin, of Washington State University (United States), describes the system as “too permissive.” “
“Modest” efficiency
In terms of the use of opioid drugs, regulations are very flexible in the United States as in France. The recommendations on their use remain vague. It is no surprise that Dr. Franklin notes a gradual increase in daily doses of morphine, which increases the risk of addiction and side effects. In 2010, 16,651 accidental opioid poisonings were reported.
Morphine derivatives are widely used in the treatment of chronic pain. However, the scientific literature is far from unanimous on the subject. These drugs are not recommended for tension headaches, migraines – except as a last resort. In fact, their overall effectiveness is “modest” and their effect on function “weak”, underlines Dr. Franklin on behalf of the American Academy of Neurology. “While there is some evidence to support short-term pain relief, there is no strong evidence that this relief is maintained over long periods of time,” he writes.
A patient-doctor “contract”
In addition to being relatively ineffective, opioids are also accompanied by many immediate side effects (nausea, vomiting, constipation, drowsiness, malaise) or long term (infertility, immunosuppression, falls and fractures in the elderly, fatal overdoses. or not fatal), continues Dr. Gary Franklin. “The risks of chronic opioid use in certain chronic diseases, such as headaches, fibromyalgia or chronic low back pain, outweigh the benefits,” concludes the American Academy of Neurology. On the other hand, in the treatment of more serious diseases (destructive rheumatoid arthritis, sickle cell disease, severe collagenosis, severe neuropathic pain), such use should be subject to specific recommendations.
General practitioners are at the forefront of the fight against unnecessary prescriptions for drugs derived from morphine. The AAN therefore recommends that they be attentive to many factors, in particular the patient’s medical history, and not to exceed a daily dose of 80 to 120 mg per dose in morphine equivalent (MED). “If the dosage exceeds 80 to 120 mg per MED dose, consultation with a pain specialist is recommended, especially if pain and function have not improved,” writes Dr. Franklin.
As soon as an opioid prescription is considered, a patient / doctor “contract” should be signed by both stakeholders, suggests the author of this forum. The patient agrees to consume the drugs according to the established “contract”. And if he gets out of hand by increasing the number of prescribers or obtaining opioids in the emergency room, the doctor would be authorized to interrupt care.
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