CanadaCOMMENTARY: What about those who really do need opioids to manage their pain?

10:26  22 april  2019
10:26  22 april  2019 Source:   globalnews.ca

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Amid the opioid crisis, a message has been lost: many people live with daily pain and depend on opioid -based medications to live, this professor says. Wed, May 30: Many patients who suffer from chronic pain are facing increased stigma when they turn to opioids , according to a new study out of

The list of opioids is long. Learn their forms, factors used in choosing them, and tips for taking them safely. It’s used for chronic pain in people who need around-the-clock treatment. The generic version is available in Talk to your doctor about what substances you should avoid while taking an opioid .

COMMENTARY: What about those who really do need opioids to manage their pain? Pop-up injection site co-ordinator Sarah Blyth with a overdose naloxone kit in vancouver's Downtown Eastside January 30, 2018. The former pop-up safe injection site now has a permanent home next-door to the former temporary site.

Opioid-related deaths have been rising over recent years in North America and globally. New data released by the Public Health Agency of Canada reveals that more than 10,300 Canadians died as a result of an apparent opioid-related overdose between January 2016 and September 2018.

There is no question that this is tragic and requires attention.

The response by Canadian policy-makers, however, has focused largely on the over-prescription of opioids as pain medications. Interventions have included limiting prescriptions, increasing oversight of physicians and providing guidance for decreasing or tapering opioid medications.

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Courage to Come Back 2019: B.C. mom won’t let painful disease stop her from raising a family Every day Palmer pushes through the pain, choosing not to take opioids. READ MORE: Courage to Come Back 2019: As a teen she was told she’d never walk again. They were wrong She also dedicates time to the CRPS Hope and Awareness Foundation, which she co-founded. "We focus on increasing education and awareness in the general public, because most people have never heard of the disease," Palmer said. "There isn't really a lot of understanding for the context of what it means to live with the disease.

Much of the focus in the state's opioid crisis has been on those struggling with addiction, but many people say they need the drugs to manage pain , and

That figure includes deaths from heroin, an illegal opioid . But almost half involved a prescription "Even if the insurance covers physical therapy, you probably need prior authorisation (from the It found that Japanese doctors treated acute pain with opioids in 47% of cases - compared to 97% in

In January 2019, Ontario announced an agreement with the federal government to inject another $100 million in fighting the crisis. These funds will likely be spent on safe injection sites, naloxone kits for emergency and medical personnel, public education about how to respond to an overdose and task forces to improve pain management.

I fear this focus on pain and overdose is a focus merely on the symptoms of a broader crisis — a crisis of under-managed mental illness and unresolved emotional trauma throughout Canada. Pain and substance use disorder are linked, but they are not synonymous. The opioid crisis is not, at its root, a problem of pain.

Meanwhile, the voices of nearly one in five Canadian adults who live with daily pain seem largely unheard.

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Saxbury took a powerful opioid , oxycodone, to manage throbbing lower back pain that radiates down his left leg. Family doctors who fear disciplinary action from medical boards have dropped chronic pain patients. "Most of the time it works out really well, and there is a silver lining in many cases

She suspects that women who present to the emergency department with abdominal pain are often “When people are anxious, their pain tolerance becomes less,” she says. “It may be best to try to get their Another complication is that oestrogen alters both the perception of pain and the response to

READ MORE: More than 10,000 Canadians died from opioid overdoses in less than three years

Living with chronic pain

“Without pain meds, I cannot walk or accomplish even the simplest of household tasks. Going to the toilet will be beyond my capabilities. I have always employed narcotic pain meds to live as close to a normal life as is possible; without them I am only a burden to myself and others.”

As a physiotherapist, educator and pain researcher over the past 19 years I have heard this story, shared with me via email, countless times. In the shadow of the alarm over the opioid crisis, an important message seems to have been lost: many people live with daily pain and depend on opioid-based medications to live bearable lives.

COMMENTARY: What about those who really do need opioids to manage their pain? © Provided by Corus Media Holdings, Inc.

Many people find that opioid medications such as codeine, OxyContin, morphine or in some cases even fentanyl, can be effectively used in combination with other therapies like exercise, meditation or psychological counselling to maintain a tolerable quality of life.

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That ’s why you need to view your customers’ pain points holistically, and present your company as a solution to One of the best ways to learn your customers’ biggest problems is by really listening to them. We already knew that time management was a major pain point for agencies before we built

We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain . I can concur based on real time experience with my Mother who is bed bound with an irreparable Thank you for your comment . It is fantastic that she is able to reduce her use of opioids .

Through no fault of their own, these people are now described in the same breath with sufferers of substance-use disorders. And they find themselves in the middle of a largely North American tug-of-war between policy-makers, doctors, pharmaceutical companies and the public. Many of them find themselves unable to access the prescription opioids they need to live bearable lives.

Record number of opioid deaths

When alarms were raised in 2015 about the growing rate of opioid overdose deaths, the discourse at the time almost exclusively focused on manufacturers of opioid-based pain medications like Purdue Pharma, and the doctors that prescribe them.

The arguments were that Purdue Pharma’s aggressive marketing of the powerful opiod painkiller OxyContin as non-addictive, along with lax prescribing standards, was the cause of the crisis. The response was swift — from creating new prescribing guidelines and limits through to a very real attempt by Oregon lawmakers to eliminate opioid prescription altogether in 2018.

While there is merit to these arguments, making the opioid crisis almost exclusively about pain has given policy-makers licence to focus on dangerous metrics. Most notably, many focused on counting the total number of opioid prescriptions.

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Prescriptions of opioids have declined — from 21.7 million in 2016 to 21.3 million in 2017 — and some may laud this decline. However, opioid-related poisonings, at least according to available data, have not declined in turn.

Meanwhile, the global burden of chronic pain has increased steadily since at least 1990.

So far it seems we are losing on both fronts — opioid poisoning continues while the burden of pain increases.

COMMENTARY: Opioids are not the enemy yet the war on pain patients continues

Vending machine opioids

The opioid crisis needs to be understood in the context of a diagnosable health condition now known as opioid use disorder (OUD). Chronic pain, on the other hand, is best thought of as an umbrella disorder — most commonly defined by the duration of pain — that can take many forms.

OUD is partly a disease of impaired impulse control, characterized by an inability to stop using opioids even when faced by clear evidence of harm. While it can affect people from any background, there are increasingly clear connections between OUD and environmental factors such as homelessness, poverty and interpersonal, intergenerational and childhood traumas.

I recently explored data on access to mental health care provided by Mental Health America and compared that to data from the Milliman Group on OUD prevalence and found that states with greater access to mental health care also had the lowest prevalence of OUD.

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Ramona Poppe, 56, of Onalaska, Wash., is shown at her home in September 2018. Poppe said she understands the risk of using opioids but wants to maintain the option of using them to reduce her chronic pain from medical conditions. (Bill Wagner /The Daily News via AP)ot surprisingly then, since the introduction of opioid-prescribing guidelines in 2017 we can see a shift in behaviour of those with unmanaged OUD. For example, recent trends have shown that the primary substance in opioid-related overdose deaths is now illicit fentanyl, a drug that was rarely prescribed by physicians even before the crisis started.

In 2018, cocaine overtook opioids as the leading cause of overdose deaths in Newfoundland.

In a strange twist, forcing people with unmanaged OUD to riskier street drugs has been so devastating that Vancouver has seriously considering installing opioid vending machines.

This means we are facing a very real situation in which some people can access opioids through a vending machine while those with uncontrolled pain cannot do so through their physician.

READ MORE: 60 people, including doctors, charged in U.S. opioid prescription scheme

Let’s invest in mental health

The good news is that Ontario’s $100 million in government funds could have real impact if properly directed.

For example, advances in pharmacogenetics towards personalized medicine mean it may become routine care for doctors to prescribe the type and dose of opioids that will be most beneficial based on a patient’s genes. This line of research is also expected to improve doctors’ ability to identify those most vulnerable to substance use disorder through routine clinical screening.

Canadian hospitals reported 138 cases of lost fentanyl in one 15-month period, federal records show

Canadian hospitals reported 138 cases of lost fentanyl in one 15-month period, federal records show Vials and patches of fentanyl were reported missing from Canadian hospitals at a rate of about twice a week over a 15-month period ending on Jan. 1, 2018, according to federal records obtained by the Star. In total, the records reveal 138 incidents of lost fentanyl, including cases involving the even stronger derivatives remifentanil and sufentanil in patch and liquid forms. It’s not clear how many of the highly dangerous opioids reported missing from hospital shelves were stolen or thrown out, as the causes for the disappearance are not be captured in the figures.

This will help us get the right treatment to the right person at the right time and avoid potentially harmful treatments for those who may be at risk.

Other strategies could include investing in mental health services especially for at-risk youth. These services could arm them with resources needed to cope with trauma and stress and ensure access to alternative pain-management strategies such as physical therapy, mindfulness or cognitive behavioural therapies.

The focus on opioid prescriptions as a metric of success in the opioid crisis has not been successful. We need to think about a world after the opioid crisis has passed — to ensure that mental health services are available and that those who require opioids for intolerable pain have options.

David Walton, Associate Professor, School of Physical Therapy, Western University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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