Although it is widely accepted that taking opioid pain killers over extended periods of time can lead to "tolerance" -- needing more opioids to get the same pain relief -- there is a wealth of recent scientific evidence that opioid pain killers like OxyContin actually cause pain -- prolonging needless and excessive use of the drug, and leading to needless dependencies, addictions, and drug detox.
The standard medical view assumes that an increase in opioid dosage is sometimes required solely because of opioid tolerance. The opioid receptors in a patient's brain become less sensitive to the opioids over time, and larger doses are required to achieve the same stimulation of the receptors to produce enough endorphins to mask the pain.
For example, many patients in drug detox for opioid dependence who were originally prescribed 20 milligrams of OxyContin per day report that they eventually were being prescribed over 200 milligrams per day a year later -- but their pain was worse now than when they started taking the drug. And after a year or more on opioids, patients are nearly always dependent or addicted and wind up needing drug detox.
The new research does not question the reality of opioid tolerance, but rather reveals compelling evidence that a significant amount of the increased pain experienced by people taking opioids over time is actually caused by the opioids themselves -- not just because of tolerance to the drug.
Dr. Steve Gelfand, a board-certified rheumatologist with more than 30 years of experience in the field, wrote a letter to the FDA recently citing twenty-one separate articles and studies in the medical literature that point out the dangers of opioid treatment for pain, and the growing agreement among medical scientists that opioids actually increase pain.
A November, 2003 issue of the New England Journal of Medicine reported that "long-term use of opioids may also be associated with the development of abnormal sensitivity to pain." In the March, 2006 issue of Anesthesiology, a report stated that there is "evidence that opioids may cause hyperalgesia [heightened sensitivity to pain] and that this can negatively impact early pain outcomes."
In a 2006 issue of the Journal of Pain, Dr. Eriksen states that "...it is remarkable that opioid treatment of long term / chronic non-cancer pain does not seem to fulfill any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity."
In the May, 2007 issue of Pain Physician, Dr. J. C. Ballantyne made several key points:
There is no strong evidence supporting the long-term use of opioids for pain.
There is strong evidence of opioids increasing pain.
The idea that it is all right to increase opioid dosages when tolerance increases is in serious doubt.
Epidemiological studies are even less positive, and report failure of opioids to improve quality of life in chronic pain patients. (In fact, there is plenty of evidence that opioids are doing exactly the opposite - witness the number of people who are now living life as a drug addict and can't even stop taking the drugs without going through a drug detox program.)
And finally, in the February, 2008 issue of PAIN, the publication of the International Association For The Study of Pain, an article states that physicians should always consider opioid-induced pain sensitivity before increasing patients' dosage, because "increasing opioid dose may not always be the answer to ineffective opioid therapy, and under certain circumstances a smaller amount of opioid may lead to more effective pain reduction." Smaller amounts also may prevent addiction and the need for drug detox.
It seems clear that Big Pharma's interests in keeping people on opioids has finally found some important scientifically-supported professional opposition. We can only hope against hopes that the research reaches the right officials at the FDA. If it is broadly explained to the public that their painkillers are probably increasing their pain, and that alternatives to opioids exist, we might see fewer people needing a drug detox program to get their lives back.