I made this blog post a couple of days ago and today got around to watching the video that I shared in the blog post. The 10 minute video is made by a non-profit that seems opposed to these guidelines.
UPDATED:Proposed tapering guideline by American Society of Addiction Medicine
some well-thought-out suggestions in commenting, like references supporting your position.
My first thought was..I’m going to waste all my time digging up references to what I consider common sense. Then again, I looked at who was involved with creating these proposed guidelines – a whole lot of academia types… who are focused on ADDICTION and they live and die on footnotes, citations, and references.
My whole life has been driven by the motto “work smarter not harder…” I was tired and decided to take a nap, I turned on Pandora on my iPhone to listen to “My 60s Music Station”. My mind decided that “job one” was to find a shortcut to get answers and references!
I have been playing around with a couple of AI Chats for a few weeks. Asking them questions and what they come back with – normally within SECONDS – has often been IMPRESSIVE!
I put on my Pharmacist and my chronic pain advocate hats and started thinking about how chronic pain and anxiety intersect and how forced tapers and increased anxiety interact.
So I asked the latter chat above: studies of chronic pain patients being forced tapered and anxiety levels increase and this is what I got back, including citations – SON OF A BITCH!
Based on the search results, there is evidence that tapering opioid medications in chronic pain patients can lead to increased anxiety levels and other negative outcomes:
1. Suggesting an opioid taper can trigger extreme anxiety in patients. Physicians are advised to acknowledge this anxiety, normalize it, and express empathy when broaching the subject of tapering[2].
2. A large study found that opioid dose tapering was significantly associated with increased risk of mental health crisis. Specifically, tapering was associated with an adjusted incidence rate of 7.4 mental health crisis events per 100 person-years compared to 4.3 events in non-tapered periods[3].
3. The risk of mental health crisis was even higher for patients tapering from higher baseline opioid doses. The study suggests that “especially careful mental health monitoring may be warranted for patients tapering from higher opioid doses”[3].
4. Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings[4].
5. Anxiety and fear-based beliefs and behaviors have been strongly implicated in negative outcomes for chronic pain patients. Studies have shown that fear of movement and reinjury is a better predictor of self-reported disability than biomedical findings or pain intensity levels[1].
6. The fear of pain can create a self-perpetuating dynamic where patients avoid physical activity, leading to deconditioning and further disability. This same dynamic may apply to opioid use, as patients associate taking opioids with avoiding pain[1].
While these studies don’t specifically focus on “forced” tapering, they do highlight the significant anxiety and mental health risks associated with opioid tapering in chronic pain patients. The research suggests that tapering should be done carefully, with close monitoring of patients’ mental health, especially for those on higher doses. Physicians are advised to approach the topic sensitively and provide support throughout the tapering process to help manage patients’ anxiety and other potential negative outcomes.
Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427345/
[2] https://www.aafp.org/pubs/afp/issues/2020/0101/p49.html
[3] https://jamanetwork.com/journals/jama/fullarticle/2782643
[4] https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.820357/full
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754260/
Filed under: General Problems
All books ever written,started w/the experience 1st,,an foremost,,and this is where is alll went off the rails,,,our true expereinces,,,has purposively been LEFT OUT,,CENSORRED,, thus the academics have obviously got this all wrong,,and when their arrogance gets in the way of the truth,ie our experience’s,,people die,,,,and we are literally dieing from forced physical pain,ie,we are being medically tortured to and till death,,thats a fact,they also want censorred,and are doing a good job at both,,censorring and killing us,thru the use of forced physical pain,ie,tortured to death,,,,how humane of the academics’,,and tell me again why is wrong to strongly dis-like them??maryw
Thanks…great stuff. But who in this world of plotting to commit pain patients to a life in a wheelchair
AND those of over 80 to an assisted living facility or higher level of care is going to help us get out of this mess…it is like the abortion issue…kill the mother who suffers complicated pregnancy…. These politicians and judges are killing us. Slowly!
Not sure what you mean? pharmacist Steve brings up several excellent points.. An academic response is all that suffices. Unless people walk in these patients shoes we will not be able to have our own opinion.
Here is another reply I got from a ChatAI: 19%+ of our country deal with some anxiety. The CDC dosing guidelines messed with close to 30% of our population. I am sure than many in the first group are also in the second group. In their proposal – NO ONE SHOULD BE ON A BENZO MORE THEN 4 WEEKS. Sit on your hands and just like the CDC limited opioids to a fabricated MME of 90/day… it would appear that their goal is stop all pts on benzos, because this group deals with addictions… and IMO.. their opinion of preventing addiction is PROHIBITION
And here we go with round Number next I have academic Insanity that potentially destroy our lives. When will the gas lighting ever end?