How many Long Term Studies over a year on OPIOID USE??

Chapter 2. The CDC acknowledged some unintended consequences due to misapplication or misinterpretation of the guidelines, including forced tapers and patient abandonment. In 2019, the CDC clarified that the guidelines do not suggest discontinuation of opioids prescribed at higher dosages. In conclusion, while the 2016 CDC guidelines led to an overall decrease in opioid prescriptions, their impact on CRPS patients appears to be less pronounced. CRPS patients continued to receive opioid prescriptions at higher rates than the general population, possibly due to the complex nature of their pain condition. However, the guidelines likely influenced prescribing practices for CRPS patients, particularly in terms of dosage and concurrent use with other medications. The main criticisms of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain from the Complex Regional Pain Syndrome (CRPS) community included: The guidelines were often misapplied as inflexible rules rather than recommendations, leading to rigid dose limits and duration restrictions that did not account for individual patient needs. There were concerns about the guideline being used to justify actions contrary to its intent, such as forced tapering or discontinuation of opioids for stable patients. Critics noted a lack of pain management specialists involved in developing the guidelines, potentially leading to recommendations that did not fully consider the complexities of conditions like CRPS. Medical professional organizations expressed concern about the scarcity of pain experts represented in the Core Expert Group that helped develop the guidelines. Reports emerged of patients experiencing harm due to clinicians suddenly discontinuing long-term opioids or stopping opioid prescribing altogether. Some patients reported untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, and psychological distress as a result of misapplication of the guidelines. The guidelines were sometimes incorrectly applied to patient populations not intended to be covered, such as those with cancer-related pain or receiving palliative care. There were concerns that the guidelines could impede access to comprehensive, multimodal pain care for CRPS patients who may benefit from carefully managed opioid therapy as part of their treatment plan. Critics argued that the guidelines focused too heavily on reducing opioid prescribing without adequately addressing alternative pain management strategies for complex conditions like CRPS. These criticisms highlight the challenges in implementing broad guidelines for complex pain conditions like CRPS, where individualized treatment approaches are often necessary. The CRPS community's criticisms of the 2016 CDC guidelines were largely aligned with those from other patient groups and medical organizations, though with some specific concerns related to the complex nature of CRPS pain. Key similarities in criticisms included: Both CRPS patients and other chronic pain groups argued that the guidelines were often misapplied as inflexible rules rather than recommendations. There were concerns about rigid dose limits and duration restrictions that did not account for individual patient needs, particularly for conditions like CRPS that may require higher doses or longer-term treatment. CRPS patients, like other chronic pain sufferers, reported experiencing harm due to clinicians suddenly discontinuing long-term opioids or stopping opioid prescribing altogether. Both groups noted issues of untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, and psychological distress as a result of misapplication of the guidelines.

Chapter 3. The CRPS community, along with other patient groups, expressed concerns that the guidelines could impede access to comprehensive, multimodal pain care for patients who may benefit from carefully managed opioid therapy as part of their treatment plan. Critics from both the CRPS community and other patient groups argued that the guidelines focused too heavily on reducing opioid prescribing without adequately addressing alternative pain management strategies for complex conditions. Concerns about the guidelines not adequately addressing the management of patients with severe, long-term pain conditions like CRPS. The potential for misapplication of the guidelines to negatively impact CRPS patients who may require higher opioid doses or longer-term treatment compared to other chronic pain conditions. Overall, the CRPS community's criticisms aligned closely with those from other patient groups, reflecting a shared concern about the impact of the 2016 CDC guidelines on pain management and patient care. Advocacy efforts have brought attention to the high rates of psychiatric comorbidity in CRPS patients, with 77.2% reporting feelings of depression and 78.2% reporting periods of anxiety. This has led to increased recognition of the importance of including mental health support in CRPS treatment plans. Some healthcare providers may still be unfamiliar with or skeptical about CRPS, highlighting the ongoing importance of advocacy efforts. In conclusion, while CRPS advocacy has led to significant improvements in the relationship between patients and healthcare providers, there is still work to be done to ensure optimal care and understanding for individuals with this complex condition. Hernandez v. United States (2010) The plaintiff successfully argued that her CRPS resulted from medical malpractice during childbirth. This case illustrated the importance of establishing causation in CRPS cases, relying on expert medical testimony to prove the connection between malpractice and the development of CRPS1. Doe v. Smith (2016) This case highlighted the complex evaluation process necessary in CRPS-related personal injury claims. The plaintiff was awarded substantial compensation covering future medical expenses, loss of earning capacity, and pain and suffering. What percentage of crps patients have been prescribed opioids for pain in the last fifty years from 2024. Based on the search results provided, the most recent and relevant data on opioid prescriptions for CRPS patients comes from a 2023 study examining prescription trends between January 2010 and November 2022. This study found that: 70% of CRPS patients were prescribed opioids during the 12-year study period. Specifically for CRPS-associated prescriptions, 59% of CRPS patients were prescribed opioids. It's important to note that this data does not cover the full 50-year period from 2024 back to 1974. The available information is limited to more recent years, primarily the last decade.

Chapter 4. Other studies mentioned in the search results show varying rates of opioid use in CRPS patients, but these are either older or based on smaller sample sizes. For example, one study from 2020 reported that 81% of CRPS patients were prescribed tricyclic or serotonin-norepinephrine reuptake inhibitor antidepressants, but did not provide a specific percentage for opioid prescriptions. Given the limitations of the available data, it's not possible to provide an accurate percentage for CRPS patients prescribed opioids over the entire 50-year period. However, the most recent comprehensive data suggests that a significant majority (70%) of CRPS patients have been prescribed opioids in recent years. There are limited long term studies specifically examining the impact of opioid use on CRPS patients, but some relevant data can be gleaned from existing research. A 2023 study examining prescription trends in CRPS patients from 2010 to 2022 found: 70% of CRPS patients were prescribed opioids during the 12-year study period. The average duration of opioid use for CRPS patients was 3.95 years. Opioid prescriptions for CRPS patients increased over time, despite broader efforts to reduce opioid prescribing. A long-term study on spinal cord stimulation (SCS) in CRPS patients provided some insights on opioid use: None of the 6 patients using strong opioids discontinued their use during the 2-year follow-up . The mean opioid dose increased non-significantly from 53 to 120 morphine milligram equivalents (MME) per day over 2 years in patients with SCS. Patients who had SCS explanted also saw a non-significant increase in opioid dose from 27 to 57 MME/day. Multiple sources note the lack of well-controlled studies demonstrating long-term improvements in neuropathic pain, including CRPS, treated with opioids. The benefits of using opioids may sometimes outweigh the risks. In conclusion, while there are studies tracking long-term opioid use in CRPS patients, there is a notable lack of high-quality, long-term studies specifically examining the impact of opioid use on CRPS outcomes. Persistent Use: One study found that CRPS patients using strong opioids did not discontinue their use during a 2-year follow-up period. Bisphosphonates: High-quality evidence supports bisphosphonates as a first-line treatment for upper extremity CRPS, showing consistent statistically significant effects in pain relief and functional improvement. A 2023 study examining prescription trends found that 70% of CRPS patients were prescribed opioids between 2010-2022, compared to 48% of controls. However, the study also noted that opioid prescriptions for CRPS patients increased over time, despite broader efforts to reduce opioid prescribing. In conclusion more high-quality, long-term studies are needed to definitively compare the efficacy of different treatment approaches for CRPS. The initial costs of SCS are significantly higher due to device and implantation expenses. One study found that total costs of care in the first year were $39,000 higher with SCS compared to conventional medical management (CMM).Opioids: Initial costs for opioid therapy are lower, primarily involving medication expenses. According to one source, the annual maintenance cost for an uncomplicated SCS case ranges from $3,539 (CAD) in Canada to $5,071 (USD) for US Medicare patients, and $7,277 (USD) for Blue Cross Blue Shield patients. Another study estimates the annual maintenance cost to be between $5,000 and $22,000 USD. This wide range is due to variations in complications and potential adverse effects. One analysis showed that the median total cost six months post-implantation was $13,305, which included maintenance costs. Studies report complication rates of 30-40% for SCS patients. Common complications include: Hardware-related issues: lead migration, lead fracture, device malfunction. Biological complications: infection, pain at implant site. 83000 DEATHS recorded from 2018 through 2008. The mean cost of a complication was $5,191 CAD in Canada (range $136-18,837) and $9,649 USD for Medicare patients in the US (range $381-28,495). While initial SCS implantation costs are high, complications contribute to ongoing expenses: About 18% of SCS patients experienced device-related complications within 2 years. 22% required device revisions or removals, not always due to complications. To account for complications and maintenance, experts recommend an 18% budgetary allocation average per patient per annum above the initial implantation costs. The annual cost to maintain SCS devices, including managing complications, can range from $5,000 to $22,000 USD. This wide range is primarily due to variations in the occurrence and severity of complications. In conclusion, SCS complications significantly impact the overall maintenance costs. Healthcare providers and payers should budget for these potential expenses when considering SCS therapy.

Chapter 5 end. How long have opioids or their derivatives been used in medicinal applications for health or pain. Opioids and their derivatives have been used in medicinal applications for health and pain for thousands of years: The use of opium, derived from the opium poppy plant, dates back approximately 8,000 years. Ancient civilizations including the Sumerians, Greeks, Indians, Chinese, Egyptians, and Romans used opium for medicinal purposes. Opium continued to be used as a panacea for various ailments throughout the Middle Ages and Renaissance periods. In 1803, Friedrich Sertürner isolated morphine from opium, marking a significant advancement in opioid medicine. During the American Civil War (1861-1865), opioids were widely used to treat wounded soldiers, leading to increased use and addiction. In 1898, Bayer Company introduced heroin as a supposedly less addictive alternative to morphine. Opioid pain medications were primarily used for acute pain and cancer pain until the 1990s. In 1995, OxyContin was approved, leading to a significant increase in opioid prescriptions for chronic non-cancer pain. Opioids continue to be used for pain management, but with increasing awareness of their addictive potential and associated risks. In conclusion, opioids have been used medicinally for at least 8,000 years, with their applications evolving significantly over time, particularly in the last two centuries. How many long-term studies on the impact of opioid use on CRPS patients have been completed to date. Based on the search results provided, there appear to be very few long-term studies specifically examining the impact of opioid use on CRPS patients: A 2023 study examined prescription trends in CRPS patients from 2010 to 2022, finding that 70% of CRPS patients were prescribed opioids during this 12-year period. However, this study did not directly assess the long-term impact of opioid use on patient outcomes. A retrospective study with a median 8-year follow-up of CRPS patients using spinal cord stimulation (SCS) found that none of the 6 patients using strong opioids discontinued their use during a 2-year follow-up period. The mean opioid dose increased non-significantly in both SCS users and those who had SCS explanted. One study mentioned that CRPS patients were prescribed opioids for an average of 3.95 years, compared to 1.3 years for non-CRPS controls. However, this was an observational study and did not evaluate long-term outcomes. These studies provide some insights into long-term opioid use patterns in CRPS patients, but they do not constitute comprehensive long-term studies on the impact of opioid use in this population. The available evidence suggests a lack of well-designed, long-term studies specifically examining the effects of opioid use on CRPS patient outcomes. So after 8000 years of providing relief from suffering, not ONE STUDY has been performed on the long term effects of it's usage on Pain Patients. Not ONE Long Term Study...THEN WHY DOES THE MEDICAL COMMUNITY PRETEND TO KNOW iT ALL WHEN IT COMES TO USING AN OPIOID FOR PAIN RELIEF AND THE RETURN TO QUALITY OF LIFE FOR SUFFERING/DYING PAIN PATIENTS? Not One Long Term Study of Over 6 months that I can Find. How About You Mr. Doctor? DO NO HARM - JUST DO NOTHING FOR PAIN PATIENTS. GOD BLESS ALL THE SUFFERING AND DYING PAIN PATIENTS. AMEN! 8000 YEARS...really?

I agree with you, my GI doctor actually recommended writing me a medical marijuana prescription, which I didn't do. However I see a spine pain management specialist who refuses to write anything other then NSaids which I can't take due to GI issues. I have severe cervical stenosis which I am doing my best to avoid surgery but not sure how much longer I can take.

NSAIDs damaged my Kidneys, Surgeries gave me CRPS Type 2 and Medical Marijuana is not available in Indiana. Pain is not even the worst part of CRPS. It can take years before you get the help you need. I pray you find an answer to your suffering ASAP. Good Luck.
Craig