Hi Everyone,

Recent studies have shown that neural plasticity associated with the development of opioid tolerance may activate a pronociceptive mechanism that could counteract the analgesic effects of opioids. Thus, exposure to opioids could lead to two seemingly unrelated cellular processes.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16499832

Hey.

This does really make sense!!!!

Thanks for posting it

Rosie xxx

Hi guys,

Adding my 2 cent input, based primarily on 27 years of daily opioid usage but also on a fair amount of researching the medical literature generally:

I have mentioned before that despite courses in research methodology and statistics, I prefer abstracts over full articles; to really understand articles you need to understand what all those darn numbers mean, otherwise they just get in the way of reading the text. All I really want to know is what is being investigated, some idea about the methodology, what was learned and whether they claim some scientific validity.

Abstracts generally provide this information, and while this method of "research" means I can't confirm any data, I have no plans to bring myself up to date on statistics so it doesn't really matter. I don't bother reading abstracts that don't have any methodological information, this generally means that the article is a lecture; speculation; or just another sign of the "publish or perish" environment in academia. This abstract appears to be of the latter type.

We are all tought in research methods 101 not to use the word "proved", there are stronger words than "may" or
"could".

Opiod tolerance is a fact; one we need to guard against constantly. Unfortunately, my personal experience and everything I have learned from other 'pain people', the only way to limit tolerance is to tolerate as much pain as you can. The more you try to limit the pain, the more rapidly tolerance develops. This is not a fun way to live your life, but I was 36 when I was injured, knew I faced a long future of pain, and understood that there is a limit to the amount of opiods one can take before side-effects become more significant than the pain itself.

Finally, I view articles like this with a certain amount of fear: That they will be used to justify political limitation of a physician's right to treat pain.

I realize that the possibility that opiods may activate a pronociceptive (literally: increased pain sensitivity), mechanism, means that it should be researched, but even this brief an abstract would be more helpful if it suggested some sort of research, or even better, suggested a way to research how to turn off such a mechanism.

Those of us who live with pain face the fact that no useful alternative to opiods is currently being discussed in the context of the next few years, and the only way the DEA can keep getting increased budgets is to find new ways to fight drugs; we don't need them interfering further into the physician-patient relationship.

Physician overprescription of Lipitor (due to various "kickback" mechanisms), is probably a greater danger to public health, and certainly to increasing medical costs, than overprescription of opiods, and DEA aggressiveness in going after doctors is already adversely all of our lives...Vic

Hi Vicc,
I do not mean to worry anybody. If this is a concern or a worry I will certainly delete the prior post.

I am 6 weeks post OR cervical spine surgery, C 4-7. So I can not type very much. Please bare with me.

The last 4 years I have probally been on just about ever opioid their is. This is including DURAGESIC PATCH, MORPHINE and the list could go on and on.

I personally have just started reading about opiods causing more pain sensitivity. This is the last thing I personally want with this RSD stuff.

I could be wrong my Pharmy. skills are not what they should be. But I don't think Ketamine is a opioid. Because I am Type 2 I just don't think this would work for me.

In the States their doesn't seem to be much Research on Pain MGT. going on.

I really don't know what to do myself about this delimina. I am coming up with 5 years of this RSD/TOS stuff. I was on NSAIDS the first year which caused horriable stomach pains. So that's out as well for me.

It is wonderful to have you back.

Be good To You, Hugs, Roz

Hey Roz.

Please don't delete it, and I'm terribly sorry for leaving the wrong impression.

Whenever possible, my posts list things in order of importance to me, and your posting it didn't raise my fears; the fact the abstract was written with negative connotations but no suggested solutions for our need for opiods was upsetting.

My main point in posting was to make some suggestions about one way to read and sort out research from opinion and why I don't think this abstract really tells us anything, but equally important (to me) was to pass on what I've learned about delaying opiate toleration.

Nearly all of my pain is from spinal nerve injuries and can be managed with opiods, so I'm (kinda) lucky there. I know, however, that most people here suffer RSD pain that opiods barely touch.

Reading that last paragraph makes me realize how pretentionous I must seem when I appear to be lecturing RSD people about pain, but I think my point is still valid; especially when I talk about side-effects eventually becoming greater than the original problem. (I'm talking about years of opiod use).

I have heard from nurses about cancer patients who finally refuse morphine because of the added pain from severe constipation; but my main point is the risk of reaching a time when tolerance approaches 100% and there is nothing else that will relieve the pain.

Some of you know that I believe RSD has a non-neurological cause and may be treatable. I honestly believe that everyone here will see the day finally come when medicine catches up with this disease and that treatment becomes available and widely used.

That treatment is hyperbaric oxygen, but before it becomes acceptable, the medical profession must learn what this disease really is; the article I have so far failed to finish is a small first step in the process.

The reason I have written so much about why this is an ischemia-reperfusion injury (IRI), and spent so much time trying to explain the IRI process is that there is no reason why anyone should pay any attention to me about HBOT until I can persuade them of the real cause of RSD. It took me four years to learn the connection between RSD and IRI, and I am trying to shorten that process for others.

If God allows me to finish my article, I hope to see it published in the Journal of Undersea and Hyperbaric Medicine; a great goal for a lowly social worker, but HBOT has been described as a 'cure in search of a disease', so I will never find a more receptive audience. All I need to do is line up the facts and present them, right? So why can't I?

Anyway, after rereading what I've written, I can only say that if I'm right, most of you won't face years of needless pain, and if I'm wrong, talking about opiod tolerance can't hurt...Vic

Roz, what is this deleting post business?
atb