The study of opiates working well for long term chronic pain – that they said DIDN’T EXIST ?

Opioid Treatment 10-year Longevity Survey Final Report

https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/opioid-treatment-10-year-longevity-survey-final-report

Patients in this study were found to be functioning quite well after 10 or more years on generally stable opioid dosages—with the vast majority able to care for themselves and even drive.

About eighteen months ago, I approached the publisher of Practical Pain Management to assist in a survey of long-term, opioid-treated pain patients. Rightly, as any good publisher, he asked why should I go to the time and expense to do a longevity survey? I then presented him my laundry list of reasons for doing the survey. Some explanations of my reasons for doing this survey are given here. Quite frankly this survey was needed, since we simply have little data on opioid long-term treatment.1,2 Also, opioid treatment is constantly under attack, so it seems logical to see if the popularity of this treatment is justified.

Reasons for the Survey

First, recall that we have just finished the “Decade of Pain.” Ushering in this decade were many laws, regulations, and guidelines—promulgated in many states—that encouraged physicians to prescribe opioids without fear of legal reprisal. Did anyone get help this decade? Did this political and humanitarian effort pay off?

Secondly, my own experience in practice was the predominant factor. I started my pain practice in 1975 while serving as a Public Health Physician in East Los Angeles County. Cancer and post-polio patients needed ‘narcotics’ (the common name prior to the more correct usage ‘opioids’) treatment for their severe chronic pain. I’ve now followed some chronic pain patients still taking opioids after 25 to 30 years.1 Also, I was a government consultant in the 1970s on Howard Hughes who managed to survive 30 years with intractable pain after a 1946 plane crash. His average opioid dosage over that time period was about 200 mg of morphine equivalence. But are my patients unusual or simply responsive to an overzealous clinician? Do opioid-treated patients in the hands of other physicians do just as well over a long period?

A little over a year ago there was another reason to do a longevity survey. At that time there was a vitriolic, anti-opioid propaganda campaign being waged. Some prominent academic institutions, pharmaceutical companies, professional organizations, and journals, almost in unison, essentially claimed that opioids shouldn’t be prescribed due to hyperalgesia or other as-yet unnamed complications. Some parties stated that opioids, if prescribed at all, should have a dosage restricted to some arbitrary number such as 200mg of morphine equivalence a day. Some claims fundamentally suggested that pain should only be treated with non-opioids, because opioids actually “cause pain.” Amazingly, some detoxification centers actually advertised for “clients” on the basis that the person’s pain would be cured if the patient spent $10K or $20K to detoxify from opioids. Needless to say, the anti-opioid campaign was hardly backed by bonafide medical management pain practitioners or scientific studies. So what was needed was a simple survey to see if there are long-term opioid-treated patients who are still doing well.

What the Survey Can’t Determine

This survey was not intended or designed to answer some ancillary questions. Not answered is which opioids are superior or could patients have done as well without opioids? Also, it wasn’t intended to determine optimal dosage or complications. The intent was clear and simple: Do some opioid-treated patients improve pain control, function better, and enhance their quality of life over a 10-year period?

Survey Methods

In early 2009, an advertisement was placed in this publication to identify any physician who had a cohort of chronic pain patients they had treated with opioids for 10 or more years and were willing to share outcome data. Three physicians, one each from Kentucky, Louisiana, and California, reported a total of 76 patients who have been treated with opioids for 10 or more years. These, together with the 24 patients treated by this author,1 provide a cohort of 100 patients who have been treated with opioids for 10 or more years and serve as subjects for this survey. Physicians completed a survey questionnaire for each patient that inquired about demographic status, cause of pain, opioids currently used, basic physical functions, activities of daily living, and stability of opioid dosage.

Results and Findings

Patients in this study appeared typical of most chronic pain patients in that they are primarily middle age or older and have degenerative diseases of the spine, joints, or peripheral nerves (see Tables 1 and 2). Most have maintained on one opioid, although some patients required two or three. The majority have been on stable dosages for many years (see Table 3). Despite the longevity of treatment, most function quite well. The vast majority of patients report good function in that they can dress, read, attend social functions, drive, and ambulate without assistance (see Table 4). Almost half (45%) reported they had been on a stable opioid dosage for at least 3 years.

Table 1. Demographics of 10-Year Opioid Patients
Age (Yrs) Range 30-83
Males 61 (61%)
Females 39 (39%)
Length of time in opioid treatment 10 – 35 yrs
Stable opioid dosage without significant escalation 3mos – 31 yrs
Table 2. Causes of Chronic Pain in This Population (N=100)
Spine disease 51
Arthritis 16
Peripheral neuropathy 14
Headache 10
Knee diseases 5
Abdominal adhesions 5
Hip diseases 4
Shoulder/arm diseases 4
Fibromyalgia 4
113*
*Adds up to more than 100 as some patients had more than 1 diagnosis.
Table 3. Opioids Currently Used by These 100 Patients
No. of Opioids Currently Used N(%)
1 62
2 26
3 12
Opioids Currently Used
Hydrocodone 56
Oxycodone 25
Fentanyl 15
Morphine 13
Methadone 8
Propoxyphene 8
Hydromorphone 5
Other 6
Table 4. Activities and Functions in These 10-Year+ Opioid Patients (N=100)
N(%)
Dress without assistance 82
Attend church/social events 89
Read newspapers, books, magazines 97
Gainful employment 25
Care for family 61
Ambulate unassisted 85
Ambulate with cane 5
Drive a car 74

Discussion

Recent epidemiologic studies indicate that about 10 million Americans now take opioid drugs for chronic pain control. This relatively recent and dramatic occurrence has had little outcome study.1,2 The author recently reported 24 Southern California chronic pain patients who were treated with opioids over 10 years and who had positive social, physical, and functional results.1 Outcomes from other patients treated by other physicians in other geographic areas were needed to confirm or deny the positive outcomes found with one physician in one geographic area. As stated above, this survey was not intended and doesn’t imply that there are patients who may have done as well or better if treated differently. Also this survey does not include patients who did not respond to opioids or stopped them due to complications.

This survey doesn’t lay claim to any sophisticated epidemiogic methodology or randomization. All this survey intended to do was meet one fundamental goal: “Are there chronic pain patients in the United States who have taken opioids over 10 years and report less pain, better function and have a better quality of life?” This survey satisfies this simple goal.

Conclusion

Patients reported here are functioning quite well after 10 or more years in opioid treatment. The vast majority can care for themselves and even drive. Opioid dosages have generally remained stable for long periods without significant escalation. Given the findings here, there is no obvious reason to discourage opioid use or encourage pain patients to cease opioids.

6 Responses

  1. Recently I discover’d another big possible reason why they wanted this HONORABLE Doctor w./more awards for excellent service then mother Theresa..When I started reading thru tht 250++ page load of crap recently put out by the hhs Evidence Based medicine ,ie false evidence,,institution,,I started noticing all these charts ..Within these charts I see that b.s. study from Krebbs,,,and I see <50 me,,,of opiates used for this study,on their charts..R U KIDDING ME,,,LOWER THEN 50 ME THESE PATIENTS WERE ALLOWED???Well dammit,,,,this is why no-one got relief from the opiate medicine they were given,,,,these are completely NON-EFFECTIVE dosages…Then I started seeing other studies,,,same thing,,<90 me,,,or <50 me…Sooo,,,once again folks,,we are correct,,,these ''new 133,'' studies are bullshit,,,no-one would get effective pain control on those low doses,,no-wonder their all claiming opiates non effective,,,NEVER EVER STATING OPIATES WERE GIVEN IN SUCH LOW DOSAGES TO ANYONE!!!!!,,HAS ANYONE EVER HEARD THEM STATE THEE AMOUNT OF MEDICINE USED IN ALL THESE STUDIES CLAIMING OPIATE MEDICINE DOESN'T WORK??,,This also shows the complete prejudice corrupted bias by those who accepted these 133 new studies as EVIDENCE BASED,,,,BY EVEN ACCEPTING THEM AS EVIDENCE W/ out DISCOLSING TO ALL THE DOSAGE OF OPIATE MEDICINE THEY ARE WILLINGFULLY HIDING A VERY KEY IMPORTANT FACT!!!ON PURPOSE MIND YOU!!!!Then of course w/in this charts it also states functioning levels were still poor,,,thus claiming all of us liars stating we needed are medicine in order to function,,essentially calling all of us liars and just addicts,,but again,,they never exposed such low dosages were used for all these studies!!!!!well dahhhh,,no shit sherlock,,,Only 1 man had the numbers,the research that proved,at effective dosages opiates work,,,that man,,that doctor was Forest Tennant and make no mistake,,,,they knew it,,,ie why they destroyed him!!!

  2. If I had known about this survey, I would have volunteered to take it. I could have shared it and maybe helped get more people to do also. But the facts are still correct with only 100 participating surveyed. Long term pain medications are effective! Why else would pain patients be taking them if they didn’t?
    *With All the lies Been Told by uneducated MSM, but honestly I believe they’re just parrots for the Gov Agenda. This has been the agenda all along to force pain with people to suffering. This is apart of the NWO/ OWO Agenda 21.
    The De-population section of the agenda.
    And boy haven’t they made progress.
    The state of this country is raging mess!

  3. Given the findings of Meijer et al at Leiden last year, that the mammalian biological clock runs on dopamine and morphine, both endogenously produced, it is unsurprising that opiate effects remain stable as dosages remain stable. What is surprising, is that 34 years after the discovery of endogenous morphine, anyone still believes that the scary old myths about “tolerance” and “loss of therapeutic effect” are still believed, even by uninformed medical professionals.

    A script reviewed by actor Kevin Spacey explored a similar problem. I was part of a focus group that evaluated the story and despite our recommendations, Mr Spacey couldn’t raise the money to produce a motion picture narrative feature from it. The story is relevant to today’s irrational opiohobia so here’s the summary:

    Leon Czolgosz sought to impress fellow anarchist Emma Goldman by murdering US President William McKinley. He attacked President McKinley in a dining room and was knocked unconscious by a chef armed with a skillet, but wounded the President in the belly with a single bullet.

    George Westinghouse and Nikola Tesla offered the country’s only portable X-ray machine to diagnose the President’s condition. The surgeon treating him refused all help, preferring traditional ways. Among the traditional ways: the surgeon did not wash his hands before operating.

    It had been known for 25 years that bacteria cause infections and surgeons should keep things sterile to prevent them.

    The doctor treating President McKinley simply didn’t believe 2-1/2 decades of scientific evidence absolutely proving that germs cause infections and sterile techniques prevent them.

    Vice-President Theodore Roosevelt left on vacation after the surgery, with everyone expecting President McKinley to recover from his wounds. Four days later a county sheriff in upstate New York rode a team of deputies on horseback through the Adirondack woods, to find Mr Roosevelt and inform him that he needed to be sworn in as President, for Mr McKinley had caught an infection in his surgical wound and had.died of septic shock.

    The ludicrous beliefs of the Germ Deniers were remarkably similar to those of today’s Opiophobes. Supposedly infections were caused by a weak will to live, and thinking strong, “positive” thoughts would prevent infections. Medicines might endanger the patient by rewarding “weak” or “negative” thinking. Pasteur’s Discovery that sterilizing wine and beer prevented them from becoming vinegar, but that couldn’t be relevant to the science of infection because drinking is an unhealthy habit if done to excess.

    In short, doctors who did not want to learn new things, resisted learning until something so disastrous happened, that they faced ridicule for refusing to learn.

    We’re facing quite a disaster affecting pain patients.

    When will be our McKinley Moment?

    What will finally make the Opiophobes look as ignorant, stupid, conceited and dangerous, as they truly are?

  4. I HAD to be started on MEDICATION almost 25 years ago after being diagnosed as falling into the category of failed back surgery “syndrome”‘ I DID ALL THE PHYSICAL THERAPY, injections, infusions, counseling and the pain would NOT stop after two spine surgeries. It was and IS still unbearable. My children were teenagers getting ready to graduate high school and were headed for further school….college. I was 37 years old after my second low back surgery was done. I had a building business, a good business at that age already for about 14 years. Life was good before back trouble. I don’t “blame” anyone. I was never hurt so to speak, injured, but, I did have “disc” issues. The second surgery required plates, screws…….metal to stabilize the spine. After heal time the spine was as stable as it would get, ever. Further surgery was NOT an option as per the diagnosis of the surgeon. MEDICATION was the ONLY way to not fail my family! I was on a stable dosage (in excess of 90 mme) for 14 YEARS at the first pain management doctor, I have been at the current pain management facility for 9 MORE years even reducing the SAME medication as with the first PM specialist by 20 percent and had not even asked for more medication the entire 9 years. Then, January, 2017, forcefully reduced in medication by 80 percent after some 20 years or so….life changed, for the worst. I HAD to give up my business, FORCED to file for SS Disability and now I am a prisoner in my own home. I am THANKFUL for the sufficient, efficient, medication I received so I could help our children get a decent start in life. IF I could be prescribed the amount, dosage, of medication I was getting before the 2016 CDC “guideline” for opioid prescribing physicians was forced on every poor soul that needs the medication………would I still want it, need it, take it? DAMN RIGHT I WOULD! The medication saved MANY aspects of my life AND helped me to stay on my feet, own and operate my hard earned business. I have all but given up on dot/gov “coming to the rescue” especially since it is the SAME “experts” that started the needless, pointless, fallacy that ALL prescribed MEDICATION patients are”addicted” to or “diverting” our personally prescribed ( only thing that works) MEDICATION!

    • Hayden, you have been “put in your place”.
      Are you going to just roll over for it and suffer untill death?
      Is this post the end of your story?
      Please tell the readers what your plan is.

      If you have no plan, let’s make one, for both of us and any others.
      We will likely have to make our own laws and enforce them by necessary means. Such has been successful as we are (were) living the victory of it. Consider also that we are all a “Family” and could organize, in a manner to persuade for our goals. Both types of organizations have been effective throughout American history.

      If it cost our lives….. will, it’s a no brainer!

      • Yeah, I agree but, when you have contacted a medical board often enough with no malice intended and dot/gov “visits” you personally, it IS a persuader. I have no intention of “rolling over” because I have done…..no wrong. Just have to recharge.

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