Opioid prescribing "culture"

[QyX]

So, I just read this opinion article in the Washington Post by some doctor about opioids and while he makes a few really good points, I think it is exactly the opinions of people like him, that make it so difficult for RLS patients to access opioids.

Here is the link: https://www.washingtonpost.com/outlook/ ... fear-pain/

While the WP is behind a paywall, I think it is still possible to read a few articles per month for free.

For him, pain seems to be mostly a psychological thing. His opinion: opioids are bad for all chronic forms of pain, patients would demand a "pain free" life and therefore pressured the poor doctors in prescribing opioids.

And while there are plenty of issues with overprescribing opioids and lack of access to non-pharmacological treatments, there are still plenty of various different forms of chronic pain.

Restless Legs Syndrome is in such a difficult spot. While many of us suffer from chronic pain related to RLS, all those non-pharmacological treatments don't really work for us, when you have severe RLS.

Meanwhile, there is plenty of good evidence, that opioids will be effective over many years for us with only minor tolerance issues, compared to classic chronic pain patients.

Opioids are probably the single most important class of drugs for RLS. You can't treat really severe RLS after augmentation without them. And since augmentation on DAs is almost guaranteed, it is questionable to even offer us those DAs when they most likely will worsen the condition sooner or later.

Why not initiate treatment with a weak opioid like Codeine or Tramadol?

I keep thinking, that many here in the forum would do better, if they had access to opioids in the first place or to higher doses in some cases. Without Kratom, some of us had a real problem.

The good thing is: there is plenty of good evidence showing how effective and save opioids for RLS are. There is even research that points into the direction of a disturbed endorphin system in RLS patients. Unfortunately it seems like that some of those studies can only be done post-mortem. So the evidence for this particular issue is limited.

However, when you look at the complete picture and look at the stories of RLS patients, I think the evidence to prescribe opioids for RLS long-term is compelling. There really should be some exception in the guidelines when it comes to RLS. You simply can't equate RLS related pain with back pain or chronic post surgery pain etc.

If for whatever reason somebody can't read the WP article, I can also mail them to you. Just leave me a private message.

I wish we could influence the public discussion a bit more and I am always afraid, the climate here in Germany could change, too. So far, I've been super lucky.

[ViewsAskew]

Well-said, QyX.

[Yankiwi]

Excelent. Read the comments, not too much sympathy for the writer.

[Frunobulax]

The problem may be that we mess too much with our dopamine and serotonin receptors in the brain, and need additional stimuli to compensate. Robert Lustigs "The Hacking of the American Mind" discusses how our lifestyle and diet can do permanent damage to some receptors. (I think there are also some youtube videos from Lustig, but I haven't watched them yet.) It doesn't discuss RLS explicitly (or at least I don't remember it), but it's still a pretty good read (also convenient as audiobook because it's not very technical, that's what I did)-- if the drugs help us (opioids, THC and more) then there could be a similar underlying mechanism.

[badnights]

It's actually not a bad article. Most of what he says I can't argue with*. The problem is in identifying WED/RLS as pain. I don't know what the difference is, but there is something different about WED/RLS sensations that makes "pain" a misleading descriptor.

I think that opioids treat WED/RLS at a much more basic level than they treat "normal" pain (surgical pain, chronic pain, etc). I mean, I think there is something wrong right at the level of neurochemical transmission and reception; vs. chronic pain where there is probably a more complicated problem at a higher level involving more variables..... not saying this quite properly because I lack the background.

*unless he is actually saying to do away with all pain medication fro chronic pain.