Why does CDC say no narcotics for pain?

[CJB]

Does anyone know what underpins this recommendation?

CFS Toolkit - Treatment and Management

Rationale for management

• Treat other illnesses or conditions occurring at the same time as CFS or underlying medical/psychiatric conditions.
• Identify the most bothersome symptoms.
• Employ drug therapy to relieve symptoms.
• Empower the patient to be active in managing the illness.

Drug therapies

• Use as few medications as possible.
• Remember that supplements and over-the-counter drugs can interact with prescription drugs and cause side-effects, please consult with a clinician before taking any of these medications.
• Start with a small dose because many CFS patients are sensitive to medications.
• Narcotics are not indicated for management of CFS-associated pain.
• Medicine for pain or discomfort should be limited to acetaminophen, aspirin, or NSAIDS (nonsteroidal anti-inflammatory drugs).
• Do not routinely use sleep medications to treat sleep problems. Sleep medication should be prescribed based on patient’s responses to a complete sleep history.
• Treat clinical depression only. People with CFS may show signs of depression, but not have depression. Prescribing drugs for depression when a person is not depressed may make symptoms worse.
• Use caution in prescribing/taking antidepressants. Some antidepressants may make individual CFS symptoms worse or cause side effects.
• While use of a multivitamin is generally recommended for people who do not have balanced diets, it is not beneficial to buy trendy, expensive vitamins that have no effect on fatigue or pain.
• Avoid unsafe herbal remedies like comfrey, ephedra, kava, germander, chaparral, bitter orange, licorice root, and yohimbe.

Non-drug therapies

• Consider complementary therapies like acupuncture, gentle massage, deep breathing, relaxation therapy, yoga, or tai chi to increase energy and decrease pain.
• Suggest stretching and light exercise before bed.
• Help patients cope with memory difficulties by suggesting the use of organizers and schedulers. Puzzles, word games, and card games are other options to help increase focus.

 

[peggy-sue]

I thought that narcotics were generally unavailable for chronic pain in the states.
Something to do with potential addiction and them being too closely associated with illegal drugs and possibly being enjoyable. Nothing actually scientific.
They're old, cheap and effective. They don't do anything for big business.

 

[SOC]

Wow. Someone is kind of clueless. Or else their written expression is pretty bad. Most doctors reading this are going to limit pain and sleep meds when those are some of the most effective quality of life improvement strategies we have.

Acetaminophen, aspirin, or NSAIDS wouldn't even touch my pain, and mine was/is very mild compared to that of most PWME. Isn't Lyrica, commonly prescribed for FM, a narcotic?

Who, more specifically than "the CDC", writes this crap?

(Sorry, must be in a grouchy mood this morning and not inclined to think too hard. )

 

[peggy-sue]

Lyrica is pregabalin - it's not a narcotic. Narcotics are your opiates. Morphine, diamorphine (heroin, by it's Sunday name), codeine etc.

 

[Enid]

Can't understand the over caution. I had (forget which one for pain following a laminectomy years ago and which no other drug gave relief). Warned beforehand about addiction etc. but nothing happened except considerable relief from pain during the really bad times. (This was in South Africa though).

 

[peggy-sue]

I've been speaking to friends recently who have been given morphine for pain, at one time in their lives. (My beloved Mother-in-law has just died, being on a morphine pump and deprived of food and water - the legal way of killing somebody. I was obviously very concerned about what she migh be experiencing.)
They all say that; "It's just WONDERFUL".
Authorities don't like folk enjoying drugs.

Enjoy your drink, responsibly (how? the only way TO enjoy it is irresponsibly).
Medicinal cannabis has the feel-good factor removed - and it's taken donkey's years to get any authority to even do a small amount of medical research using it at all - it was illegal even as a tool for drug research.
The stupidity behind this prejudice is beyond me.
The scientific knowledge that has come out of research on it is astounding.
It has led to the study of appetitive behaviour and motivation (all completely unstudied before cannabis) and
the discovery of leptin and ghrelin - a whole new area of research has opened up.

 

[SOC]

Lyrica is pregabalin - it's not a narcotic. Narcotics are your opiates. Morphine, diamorphine (heroin, by it's Sunday name), codeine etc.

Ah, thank you. I think it is the fact that the word "narcotic" does not have an absolutely clear definition that confused me. I assume then, that the CDC meant no opoid or opoid-like compounds. It's odd though, that they followed that statement by saying pain meds should be limited to products available OTC.

 

[WillowJ]

Lyrica is technically an anticonvulsant like gabapentin.

My take on the CDC's spiel is : we said CFS was a serious illness, but we didn't mean it. CFS is not a serious illness. Treat it minimally. The risk of side effects from medicine and the risk of polypharmacy is much greater than the risk of symptoms and harms from the disease. Ok, go back to your scheduled programming now (e.g. go see some real patients with actual diseases like HIV and stuff).

Of course that's dead wrong and this is why CDC needs to change their website. Maybe they should contract the PACE Analysis team to re-write it.

 

[Firestormm]

Under the NICE Guidelines in the UK:

1.6.3.1 If chronic pain is a predominant feature, healthcare professionals should consider referral to a pain management clinic

Other than that we get:

1.6.3.2 Prescribing of low-dose tricyclic antidepressants, specifically amitriptyline, should be considered for people with CFS/ME who have poor sleep or pain...

I'm sure that elsewhere in the Guidelines there is reference made to usual clinical practice or something, implying that primary care should manage the symptoms as they think appropriate.

I've never been denied 'opiates' and am on co-codamol and even Neurontin both of which have taken the edge of my different pain.

Not sure yet what the IACFS/ME Primer contains in this regard Willow. If that document is indeed taken on by the CDC you could find it being accepted by physicians I guess.

 

[SilverbladeTE]

Uk is one of the few countries still using heroin as pain relief, very effective, obviously only used in severe cases like traumatic injury etc
very low risk of addiction, actually, because it's managed, short term and patient is not an addict, thus huge difference

Another thing to blame those idiot, zealot, small-minded Puritans for :/
(Prohibition, War On Drugs etc lead to US and some others forcing many countries to stop using opiates etc, complete bull****, caused vastly more harm than good. Example being foreign doctor working in UK accidentally killed patient as he wasn't used to using diamorphine as it was banned in his homeland, form what I recall)
http://en.wikipedia.org/wiki/Heroin

And of course UK's "Opium Wars" helped set stage for all this.
http://en.wikipedia.org/wiki/Opium_Wars

 

[heapsreal]

i think the only thing to be cautious of is that its a progressive step to narcotics for pain because once your on the top shelve theres nothing left, also possibly other meds lower on the shelve maybe effective, but in saying all that if everything has been tried and the person is in chronic pain then it should be treated effectively. There are studies starting to come out showing how bad medicine is at treating chronic pain issues, mainly because of their phobia of narcotics. Plus medicine needs a test or an xray to confirm their diagnosis and treatment, they cant use common sense and a physical examination anymore. The only long term side effects are tolerance and constipation which one needs to keep an eye on.

 

[SilverbladeTE]

Heapsreal
*nods in agreement*
Docs don't (or shouldn't!) give such without good cause, they are only for extremis

Addiciton/criminality is a completely seperate issue to therapeutic use.
Frikkin Puritianical, Christian-Taliban types didn't/dont' care though and just smacked everyone down to their level of ignorance, sigh.
Chronic pain is an absolute bitch, love to see them dumb busybodies deal with it!
Many of the non-opiates used in their stead have proven to be far more addictive and deadly, which is part of the huge numbers of folk now addicted or dead ot prescription drugs in US (that has become vastly worse health crisis than the illegal drug problem, which is bad enough as is, legal or illegal, they'll all screw you up when abused)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm/

 

[Calathea]

This article seems to be naive in the extreme about the realities of chronic pain. It's surprising how many medical places are like this. My mother used to spend a lot of time in a big eye hospital in London, for instance, and the entire specialist hospital had no one at all to deal with eye pain. Some departments really don't like getting into pain management.

Paracetamol is useless for anything other than mild pain, as far as I can tell. Many people can't tolerate NSAIDs (I can't take them orally at all), and even if they can, there are problems with using them long-term.

Personally I'd have said "use narcotics and other drugs with high side-effect profiles or dependency risk, such as benzodiazepines or anti-epileptics, with caution" rather than a blanket ban.

 

[peggy-sue]

My Mother-in-law had chronic pain for donkey's years. After she had to be taken off indomethacin, she struggled with just paracetamol for a while, before finally getting a working combination of things.
A morphine patch, which was changed weekly, supplemented with oral paracetamol; she also used topical ibuprofen gel.
I only discovered recently that is was a cotton grower who had massive influence at govt. levels who was behind making cannabis illegal.
He was worried about the hemp by-product putting him out of business.

 

[alex3619]

"While use of a multivitamin is generally recommended for people who do not have balanced diets, it is not beneficial to buy trendy, expensive vitamins that have no effect on fatigue or pain."

What about trendy expensive vitamins that have been clinically proven to deal with fatigue or pain in CFS? Like CoQ10? We tend to be deficient and its needed for energy production. Further it is used to treat headaches in fibromyalgia. That was only one vitamin, others have shown benefit as recently discussed on this forum.

Bye, Alex

 

[alex3619]

On a separate issue I know of someone who was sold on the idea of a surgically implanted morphine pump. It didnt make much difference, in fact might have made things worse. Bye, Alex

 

[CJB]

Lyrica is technically an anticonvulsant like gabapentin.

My take on the CDC's spiel is : we said CFS was a serious illness, but we didn't mean it. CFS is not a serious illness. Treat it minimally. The risk of side effects from medicine and the risk of polypharmacy is much greater than the risk of symptoms and harms from the disease. Ok, go back to your scheduled programming now (e.g. go see some real patients with actual diseases like HIV and stuff).

Of course that's dead wrong and this is why CDC needs to change their website. Maybe they should contract the PACE Analysis team to re-write it.

That's pretty much my read as well.

 

[SilverbladeTE]

PS
just in case anyone was shocked by my tirade
The exteme, nasty side of Christianity has been a menace for a long time, and is as every bit as dangerous as their Moslem extremist nutbar "brothers under the skin"...or indeed their atheist brethern like Stalinists/Maoists or...the sods who've become our "bugbears" in the UK, the Spiked/LivingMarxism/Science Media Centre/Extremist Libertarian wahoos".

As noted in my thread about alcoholism, I'm alas, very much aware of the horrors and waste caused by addiction, but the incredibly hubris (if you don't like it, ban it!), callous inhumanity (either by eagerly making a profit from the addicts or condemning them without pity) is an abomination worse than the addiction itself.
So, Puritannical and callous/extremist strains of Chritanity had big effect on laws on drugs like opiates use in medicine, which they damn well should have kept their noses the Hell out of, as they were nothing to do with need, but hubris and self righteous snootery :/
(and I always absolutely LOVE it when the nastier self righteous bigots get caught out, like the homophobe evangelist getting exposed "snorting meth off a gay hookers' ass", buhaha, brilliant!! Ah ya couldn't make stuff like that up, laughed myself silly )

Part of the pain relief issue is also this crappy inhumanity, "grin and bare it!", "suffering is good for the soul!" type of religious viewpoint
Bah, scumbags! Note, even Jesus was given a " coup de grace' ", a mercy stroke. He wasn't some sicko masochist who courted martyrdom and suffering, but brought relief and healing, and wished that "bitter cup" be taken from him if possible.
Important ot note how Western ideals etc have been moulded by the way Jesus, historical, legendary or fictional as you preffer, was "airbrushed" into an Aryan (!!), sexless, martyrdom and pain seeking loon, quite different to what the early scriptures paint.
The very essence of Christianity is love and compassion. Jesus spent his time with the "low" and outcasts of society, the drunkers, tax collectors (which was also about "treachery" and other issues at that time), prostitutes etc, today I'm quite sure he'd be amongst the heroin addicts etc

Thus some gits really do not want to even think chronic pain relief is an issue.
I've had kidney stones, been burned etc, so I'm all to aware of what "acute" pain is like, and I for one think morphine is GOOOOOOOD!
Even when you cna control pain by will, the extremes are..., well kidney stones (least for me) was so bad it paralyzed you and made ya wanna puke at the same time, the pain is so bad.
Pain from ME is getting worse, the acute pains faded away. BIG difference

Friend of mine has incredible pain/issues form nasty form of arthritis and its getting way too much for her, she's been trying to get into the pain clinic at locla hospital for months with no joy :/
To an extent such unecessary suffering is down to bullshit nasty mentality that should have died out centuries ago.

sorry for thread derail

 

[peggy-sue]

I agree with you completely - it's great to hear this coming from somebody else!

 

[CJB]

If derail = enlightened, we're agreed, SB