geoffrey modest medical blogs

the CDC just came out with draft guidelines for prescribing opiates for chronic pain (see  http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0002 ​ ). these draft recommendations include the following regarding when to initiate or continue prescribing opiates. 1. nonpharmacologic therapy and nonopioid meds are preferred for chronic pain. there are no data supporting chronic opiates, so hard to recommend given their known risks, except for this little caveat: "no study of opioid therapy versus placebo, no opioid therapy, or nonopioid therapy for chronic pain evaluated long-term (>1 year) outcomes related to pain, function, or quality of life. Most placebo-controlled randomized trials were <= 6 weeks in duration". so, no data really. there is a comment that it's okay for end-of-life care (commenting that "evidence of long-term opioid therapy for chronic pain outside of end-of-life care remains limited"), which does suggest there may be benefit...

acute low back or neck pain: placebo was a bit better than opiates   MG Modest, Geoffrey (HMFP - Medicine)       To: Modest, Geoffrey (HMFP - Medicine) Thu 8/17/2023 2:38 PM A cute low  back pain and neck pain  seem to do better with placebo than opiates !!    (see  low back pain acute no better with opioids lancet2023  in dropbox, o r  https://doi.org/10.1016/S0140-6736(23)00404-X  )    Details : -- 347 participants in Australia were recruited from 2016-2022 in the OPAL trial, a triple-blinded randomized controlled trial (i.e. neither the patient nor the researchers nor the statistical analyzers were aware of what the participants were taking) -- patients were recruited through their general practitioners or hospital emergency departments with a complaint of low back pain (pain between the 12 th  rib and buttock crease) or neck pain (pain below the occiput to the most distal cervical spine) or both, having pain for 12 weeks...