Magazine article Drug Topics

Don't Deny Opioids to Patients with Pain, Plead Experts

Magazine article Drug Topics

Don't Deny Opioids to Patients with Pain, Plead Experts

Article excerpt

Though pain in America still remains undertreated, new medications and changing attitudes are improving patient access to reliable care, according to speakers at the American Association of Pain Medicine (AAPM) annual meeting, held in San Francisco recently. The meeting, cosponsored by AAPM and the National Pain Foundation, coincided with National Pain Awareness Week, from Feb. 28 to March 3.

In the past, healthcare professionals have sometimes been reluctant to prescribe opioids-considered by researchers to be excellent remedies for pain-due to fear of addiction. However, physician organizations have recently begun advocating use of opioids when truly necessary to ease debilitating pain. A recent joint statement from the American Pain Society and the American Academy of Pain Medicine noted that while abuse of controlled substances should be stopped, patients with serious pain disorders also have the right to be adequately treated with opioids.

"We are thinking about pain in a different way than we used to," said Peter S. Staats, M.D., chief of the division of pain medicine at the department of anesthesiology and critical care medicine at Johns Hopkins University. "Although not everyone should get opioids, we cannot take away this important tool from physicians."

Obstetricians and pediatricians specializing in high-risk pregnancies actually deem opioids to be among the safest drugs for the fetus, despite the unwarranted fear that they are the most dangerous, according to Rollin M. Gallagher, M.D., MPH, professor of psychiatry, anesthesiology, and public health at MCP Hahnemann University. "We must stop stigmatizing people with pain conditions and refrain from 'opiophobia,"' said Gallagher, who is co-chair of the National Pain Foundation.

Physicians are now hoping to combine opioids with other modalities and medications to increase their ability to heal pain. In an abstract presented at this year's AAPM meeting, 25 patients with neuropathic pain were treated with intrathecal ziconotide (Prialt, Elan Corp.). Ziconotide is a non-opioid, nonlocal anesthetic, developed for the treatment of severe chronic pain. The still investigational agent is the synthetic form of the cone snail peptide w-cenotoxin M-VII-A, a neurone-specific N-type calcium channel blocker. Eighteen out of the 25 patients felt significant relief on ziconotide but were unable to titrate up because of toxicity. Of the 25 patients, 21 wanted to try a combination of opioids and ziconotide to experience greater relief, Staats said. …

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