Opioids not much better than placebos at treating pain, study says
Alternative treatments are often better for noncancer pain, the study found.
- The study examined more than 26,000 people experiencing chronic pain.
- Opioids were only marginally better than placebos at treating pain and improving physical functioning.
- It's estimated that at least 2 million Americans have opioid use problems.
Opioids are only slightly more effective than placebos at treating pain, according to a new study.
For the study, researchers administered either real opioids or placebos to more than 26,000 people, all of whom were experiencing chronic, noncancer pain. The participants who took opioids reported "statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo."
Given the slight benefits and major risks associated with opioids, the researchers found that other treatments, such as ice or physical therapy, might be better options for people suffering from chronic, noncancer pain.
"The effects of opioids on chronic pain are uncertain, whereas the harms found to be associated with prescription opioids include diversion, addiction, overdose, and death," the researchers wrote in their report, published in the Journal of the American Medical Association. "Compared with placebo, opioids were associated with increased vomiting, drowsiness, constipation, dizziness, nausea, dry mouth, and pruritus (itching)."
Most medical organizations and professionals support the prescription of opioids to treat cancer symptoms. But in recent decades doctors have increasingly prescribed these drugs to treat chronic pain stemming from a variety of ailments, including back pain, headaches and post-surgical pain.
Opioids might help to reduce pain for the estimated 50 million Americans who suffer from chronic pain, but the drugs also pose serious risks of overdose and addiction. That's why the Center for Disease Control and Prevention recommends that doctors only prescribe opioids to treat pain when absolutely necessary, and only after they've been made aware of alternative treatments.
"What most physicians do not recognize is that 92 percent of people who misuse opioids do so by taking prescription opioids, and that 75 percent of individuals who use heroin report that they started misusing opioids through the misuse of prescription opioids," the researchers wrote, suggesting that people in pain first try Tylenol, ibuprofen or naproxen, which are non-steroidal anti-inflammatory drugs.
Why do doctors still prescribe opioids to noncancer patients?
The answer is likely twofold. Patients might want a quick fix to end their pain, and painkillers represent a familiar solution. Meanwhile, doctors might have enough time or incentive to explore the many possible alternative treatment options with their patients, so they end up writing a prescription instead.
"There are many options to consider when offering treatment for chronic pain that go beyond pharmacological management such as physical therapy, cognitive behavioral therapy, mindful meditation, yoga, and tai chi," the scientists wrote. "However, explaining these options to patients can be difficult and time-consuming for clinicians and helping patients access these treatment options even more difficult."
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It's one of the most consistent patterns in the unviverse. What causes it?
- Spinning discs are everywhere – just look at our solar system, the rings of Saturn, and all the spiral galaxies in the universe.
- Spinning discs are the result of two things: The force of gravity and a phenomenon in physics called the conservation of angular momentum.
- Gravity brings matter together; the closer the matter gets, the more it accelerates – much like an ice skater who spins faster and faster the closer their arms get to their body. Then, this spinning cloud collapses due to up and down and diagonal collisions that cancel each other out until the only motion they have in common is the spin – and voila: A flat disc.
It turns out, that tattoo ink can travel throughout your body and settle in lymph nodes.
In the slightly macabre experiment to find out where tattoo ink travels to in the body, French and German researchers recently used synchrotron X-ray fluorescence in four "inked" human cadavers — as well as one without. The results of their 2017 study? Some of the tattoo ink apparently settled in lymph nodes.
Image from the study.
As the authors explain in the study — they hail from Ludwig Maximilian University of Munich, the European Synchrotron Radiation Facility, and the German Federal Institute for Risk Assessment — it would have been unethical to test this on live animals since those creatures would not be able to give permission to be tattooed.
Because of the prevalence of tattoos these days, the researchers wanted to find out if the ink could be harmful in some way.
"The increasing prevalence of tattoos provoked safety concerns with respect to particle distribution and effects inside the human body," they write.
It works like this: Since lymph nodes filter lymph, which is the fluid that carries white blood cells throughout the body in an effort to fight infections that are encountered, that is where some of the ink particles collect.
Image by authors of the study.
Titanium dioxide appears to be the thing that travels. It's a white tattoo ink pigment that's mixed with other colors all the time to control shades.
The study's authors will keep working on this in the meantime.
“In future experiments we will also look into the pigment and heavy metal burden of other, more distant internal organs and tissues in order to track any possible bio-distribution of tattoo ink ingredients throughout the body. The outcome of these investigations not only will be helpful in the assessment of the health risks associated with tattooing but also in the judgment of other exposures such as, e.g., the entrance of TiO2 nanoparticles present in cosmetics at the site of damaged skin."
Do you have a magnetic compass in your head?
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