Many pain patients, who have relied on opioid painkillers for extended periods, have experienced the harsh reality of abrupt medication reduction due to physicians' concerns about legal consequences if they don’t adhere to CDC guidelines for prescribing opioids. 

Many patients who attribute their pain relief and functionality solely to these medications, report horrific suffering and a deterioration in functioning as a result of these reductions. Involuntary and/or abrupt prescription opioid reduction should never be forced on a patient who is experiencing pain relief and is showing no signs of harm.

However, there is substantial evidence that opioids are overrated for pain relief and that other approaches to pain relief may be better options. Here are five clues that this might be the case. 

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The Placebo Effect

When a patient is given a placebo, an inert substance such as a sugar pill that  has no therapeutic effect, and is told it is a powerful drug that will help them get well, they often do. This effect is so well established that in order to get a new drug approved by the FDA, pharmaceutical companies must conduct clinical trials that include a control group given a placebo. It is only when the group that was given the drug does significantly better than the placebo group that a drug is considered proven to be effective

For  example, in a clinical trial  for drugs treating inflammatory bowel disorder, pain control, and depression, approximately 55% of patients in the control groups receiving a placebo experienced significant improvements.

However, in contrast over 50% of patients prescribed opioids stop using them, either due to ineffectiveness or intolerance to side effects.

The placebo effect emphasizes  the influence of psychological and cognitive factors on a person's perception of symptoms and well-being.

Rebound and Withdrawal

Rebound and withdrawal effects further complicate matters, The rebound effect is the production of increased negative symptoms when the effect of a drug has passed or the patient no longer responds to the drug. If a drug produces a rebound effect, the condition it was used to treat may come back even stronger when the drug is discontinued or loses effectiveness.

Drug withdrawal is the abnormal physical or psychological symptoms that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence. Physical dependence on opioids can occur within a week of starting the medication. Common opioid withdrawal symptoms include sweating, goosebumps, vomiting, anxiety, insomnia and muscle pain.

When a patient abruptly discontinues opioids, withdrawal and rebound occur, leading the patient to incorrectly conclude that the severity of the pain they are experiencing is solely due to the severity of the underlying condition, rather than a reaction to the discontinuation of the medication. It is only with the passage of time without the drug that the patient can determine what the actual level of underlying pain really is.

The human body produces its own natural opioids (endorphins) to deal with pain. When opioids from an outside source are introduced to the body, the body reduces its supply of naturally occurring opioids. It takes time for the body to regain its natural capacity to handle pain.

It is irresponsible and highly damaging to patients to abruptly discontinue opioids after long term use, given these issues. With any drug that is being discontinued, slow tapering while increasing other treatment modalities works best.

Comparative Studies
 

Comparative studies reveal that chronic pain patients relying on opioid painkillers often experience worse pain, higher healthcare costs, and lower activity levels compared to those managing pain through non-opioid pain control. Additionally, studies indicate a higher likelihood of progressing to chronic pain for patients initially prescribed opioids for acute pain.

Pain Patients Who Get Appropriate Treatment While Tapering Off Opioids Do Better

A study at an intensive three week multidisciplinary outpatient pain rehabilitation program found that patients with severe and disabling pain who were taking daily opioids experienced significant improvement in physical and emotional functioning after participation in the program and withdrawal from opioids.

Conclusion

Responsible and patient-centered care needs to include patient education and consent,  slow tapering strategies for opioid painkillers and increased utilization of non-opioid treatment modalities. Multidisciplinary treatment programs have shown promise, emphasizing the need for intensive and comprehensive care for pain patients.

Pain patients need intensive, multidisciplinary treatment, not dangerous drugs. Please sign my petition to require insurance companies to cover this treatment for all pain patients at www.change.org

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