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Systematic review of research on dose reduction & discontinuation concluded, "Very low quality evidence suggests ... pain, function, and quality of life may improve w/ #opioid dose reduction."

People are dying & being disabled on the basis of "very low quality evidence."
2017 study: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but EVIDENCE on the effect of dose reduction on patient outcomes has NOT been systematically reviewed."

How "expert" can it be?
The VA funded a team who reviewed all research in English about #opioid reduction-discontinuation. 67 studies were identified, but the study quality was deemed “poor” in 76% of the 67, the lowest rating.
acpjournals.org/doi/full/10.73…
The “overall quality of the evidence was VERY LOW for all 6 prespecified patient outcomes”: pain severity, pain-related function, quality of life, opioid withdrawal symptoms, substance use, or adverse events."

Gov't-funded researchers found very low evidence for a gov't policy.
2020 study: #Vets whose medication was discontinued after 3 months overdosed or killed themselves at nearly 4 times the rate of those who continued to be treated. Those whose medicine was stopped after more than 1 year overdosed or killed themselves at 6.8 times the rate (Oliva).
One more time: Discontinuing #opioid medicines increased the risk of fatal overdoses by 4 to 6.8 times.

You know how they know that? PEOPLE DIED. A LOT of people died. When is #enough enough? Who's going to be the last person to die for this mistake?
Frank JW, Lovejoy, Becker, Morasco, Koenig, Hoffecker, Dischinger, Dobscha, Krebs. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: a systematic review. Annals of internal medicine. 2017 Aug 1;167(3):181-91. acpjournals.org/doi/full/10.73…
Oliva EM, Bowe, Manhapra, @StefanKertesz, Hah, Henderson, Robinson, Paik Sandbrink, Gordon, Trafton. Associations between stopping prescriptions for opioids, length of opioid treatment, & overdose or suicide deaths in US vets. BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…
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Jill Piggott
@JillPiggott
@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.
Read 13 tweets
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Jill Piggott
@JillPiggott
A Google Scholar search for papers about Pain Catastrophizing + #opioids had 2,530 hits since 2018. That's 76.6 times the number of papers in 00-02.

What's "pain catastrophizing"? / thread
The Pain Catastrophizing scale assesses whether people in #chronicpain engage in rumination on &/or magnification of their pain &/or how many feel hopeless.

They claim that "catastrophizing has been associated w/ #opioid craving, long-term opioid use," & misuse.
"Pain catastrophizing has been identified as a risk factor for prescription #opioid misuse in patients with chronic pain generally." Sharifzadeh, Kao, Sturgeon, Rico, Mackey, Darnall (2017). #cpp anesthesiology.pubs.asahq.org/article.aspx?a…
Read 11 tweets
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Jill Piggott
@JillPiggott
@NitaGhei I've had it with this demeaning, patronizing psychologizing of pain. Neurologists looked at the same brain imaging as the psychologists & didn't get out their hammers to construct a COLONY.
@NitaGhei Millions of "people" were getting good "medical care" before Pain Country was colonized. Then we became "patients" who need "help," not "medical care."

Without "medical care," we became "needy," which confirmed what the colonists thought of us from the start.
@NitaGhei I've been reading the minutes of the Board of Pain Colony Supervisors for several weeks. During closed meetings, they say things about the natives like this: "The extant literature demonstrates that psycho-pathology is both an antecedent and a consequence of persistent pain."
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