@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Sounds like you're lucky enough to not live with #ChronicPain if you have to read about it. My Harvard #migraine expert said I was permanently disabled in '01. I didn't want to quit. He put me on an #opioid. I kept teaching philosophy & lit until 05 & earned tenure as a result.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz When I retired, the expert who literally wrote the textbook on #migraine said I could increase my long-acting #opioid dose. I worried about a longer taper from a higher dose & went off instead. I spent 8 years in bed w/ continual hemiplegic (stroke-like) migraine.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Pain is not my most disabling #migraine symptom. I was diagnosed with breast cancer after 8 years in bed. There was no way I could make more appts in 1 month than I had in the previous 5 years. Because Dilaudid was effective as rescue, my oncologist & neurologist rx'd it daily.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz My improvement in function on low daily Dilaudid changed my life. My neurologist continued it post-cancer treatment. On average, I get at least 30% improvement in pain intensity from 24 MME (severe to moderate or moderate to mild). But I get 100% improvement in function.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Perez et al (2020) found people tapered down or off daily #opioids were up to 6.4 times more likely to receive NO medical care from any provider the year following taper or discontinuation compared with people whose COT continued. link.springer.com/article/10.100…
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Perez et al looked at 2008-14 records. Only 9.2% of the patients had a complete discontinuation of #opioids; most had their doses reduced by a median 71.4%. Complete stoppage is now common. James et al 2019 found 77% of patients had at least 1 provider initiate discontinuation.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz James et al 2019: Discontinuation of #opioid therapy in primary-care increases the risk of #overdose. "This study’s finding that overdose death was increased in patients discontinued from COT could relate to interruption of other medical care." link.springer.com/article/10.100…
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz I'm very lucky to not have comorbid anxiety or depression which are common with #migraine. But even without a mental health comorbidity, #migraine & related headache disorders put people at 4 times the risk of suicide (Breslau). researchgate.net/profile/Richar…
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz For people w/ #migraine, the #suicide risk increases 17% with each 1-point rise in pain intensity on a 10-point scale, which means that even a 30% decrease in pain from an opioid analgesic cuts a person’s risk of suicide in half (Breslau).
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Non-pain #migraine symptoms keep me bedbound. I'd rather be knitting & reading novels. Instead, I'm propped up writing white papers about rx #opioid tapers & #suicide to try to get policymakers to knock off this uncontrolled experiment for which they have no metrics for success.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz @headsUPmigraine's paper: "#Opioid Discontinuation and #Suicide: A Case Study." docs.google.com/document/d/e/2…
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz @headsUPmigraine My Harvard research doc says clinical practice trumps research. Doctors treat individuals, not averages. If your patients say an #opioid medicine improves their ability to function & get care despite the burden of continual pain, don't say "studies show." Believe them.
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