Submitted by Away-Pepper-9239 t3_11056fr in dataisbeautiful
Comments
prinsess_bubblecum t1_j877jry wrote
This infographic depicts a pain epidemic if anything
Kebo94 t1_j87oy71 wrote
You know there are painkillers besides opioids?
Steeled14 t1_j87r184 wrote
Can you list them please
Alternative-Sea-6238 t1_j87x0qf wrote
Some non-opoid analgesics include: paracetamol NSAIDs e.g. ibuprofen, diclofenac, naproxen aspirin Ketamine Duloxetine (used for.neuropathic pain) Gabapentinoids such as gabapentin and pregabalin (also for.neuropathic pain) Local anaesthetics such as lidocaine, bupivacaine, ropivacaine (can be used in creams/gels/injections) Clonidine Magnesium Alcohol (studies have found it to be superior than paracetamol in certain quantities though obviously is also addictive!) Heat/cold therapies Steroids such as dexamethasone can provide some analgesic effect TENS machines Nitrous oxide
Many of these are situational e.g. if you have a deep pain than local anaesthetic cream likely won't penetrate deep enough, but a deep injection or nerve block of local anaesthic such as bupivacaine may work wonders.
Steeled14 t1_j889qw2 wrote
Good list but yeah very situational. Also I do not know if I am an outlier but unless I have swelling I do not take NSAIDs and acetaminophen has never done much in my experience. Maybe it helped with one headache in my life haha. Tylenol liver issues and NSAID issues but they make special formulas for longer term use now (coated to not harm GI).
Gabapentinoids maybe but it has its own side effects - might not be great for neurology long term like most things though I guess but might be more pronounced in a drug like pregabalin (neuroplasticity).
Clonodine and fluoxetine don’t seem very light either not to bash them if they work great for someone and they do not mind side effects.
Local anesthesia seems to have some serious draw backs from my quick read and makes sense why I haven’t heard of it more.
I’ve known someone who had back pain from like a pinched nerve in a herniated disk get a steroid shot that lasts a long time but I don’t know how many situations that can be applied to and what steroid side effects are like.
Alcohol seems a bit meh to suggest as chronic pain reliever and magnesium seems like a long shot but if it works I’m glad for those people. I do not use pain medicine or have had issues with chronic pain so I do not mean to bash the list but yeah we are in desperate need for drugs that produce analgesia or block pain like opioids do.
Alternative-Sea-6238 t1_j88bfoz wrote
Correct in that it would be great if we had more drugs to choose from and yes, like all drugs they all have side effects, pros and cons and are situational. No drug is perfect.
Plus I listed analgesics because that is what someone asked for a list of but I didn't mean that all are suitable for chronic pain. Very little is. In fact the best therapies often aren't pharmaceutical for chronic pain.
R.e. steroid side effects they include increase in glucose levels, reduction in immune system response, a decrease in endogenous steroid production, increaser risk of GI bleeding and weight gain/hunger. Very unlikely to get these from a single injection like your friend though and actually it's unclear why single shot steroids remain so effective for as long as they sometimes do.
Steeled14 t1_j88c77d wrote
You’re good I was just looping it back into the conversation which is opioid replacements. And yes I only emphasize side effects because the drastic severities for example dementia later in life versus some tiny weight loss or gain.
designer_of_drugs t1_j88k9da wrote
Many of these are not appropriate pain relievers for outpatient or chronic use. It’s like a person who doesn’t know anything about medicine wrote the post…
UrbanSpartan t1_j88s21r wrote
We literally use all of the drugs he listed for outpatient and inpatient management. In fact many of the post op patients now get High dose Ibuprofen, acetaminophen and Gabapentin as multi modal pain control as an alternative to opioids. I prescribe many of these daily.
designer_of_drugs t1_j88sm4g wrote
Ketamine, alcohol, nitrous oxide… short acting injectable local anesthetic. None are reasonable for chronic pain management. Additionally the evidence for gabapentoids working outside neuropathy is extremely poor.
I didn’t say all were impractical, I said many.
…and high dose NSAIDs will end up killing more of your chronic pain patients than opioids.
Obviously multimodal is the way to go, but it’s also wrong to pretend we have easy, effective solutions for opioid replacement.
Alternative-Sea-6238 t1_j88lnu6 wrote
Firstly my post was simply a list of analgesics. That was what was asked for.
Secondly you may think that. And you are obviously entitled to your opinion. Your opinion is not seemingly well based in fact. Or perhaps maybe your reply is by someone who who doesn't know about outpatient or chronic pain use. I don't know.
I mention paracetamol, naproxen, ibuprofen, diclofenac, gabapentin, pregabalin, duloxetine, magnesium, local anaesthetics, heath and cold therapies, all of which are available and appropriate for some outpatient or chronic use. So basically the majority of what I listed.
designer_of_drugs t1_j88m0xx wrote
You made a list of drugs that are not practical for most situations. It gives a totally misleading picture of the state of pain management as is related to opioid replacement.
Alternative-Sea-6238 t1_j88nup7 wrote
I made a list of drugs for pain relief as that was what was asked for. There are very few situations (arguably none) in which all drugs are practical.
Expecting any drug to replace opioid is very unrealistic at this time and as I have commented on, dealing with chronic pains should be multidisciplinary and not entirely reliant on just pharmaceutical therapy for the most effective way of tackling the issue.
One of the largest barriers is tackling patient (and indeed many healthcare provider) mindsets and psychologies. Opioid rotation is not a long term solution. Opioid reduction is the main aim but requires a huge turnaround of thinking/effort/money.
Prevention is better than cure generally. Stopping the opioid problem in a patient beforenit deveoops into a massive chronic issue is far better than trying to sort it when they aren on 160mg BD and it's five years down the line. One situation that can be worked on is the acute pain apatient who comes to hospital (e.g. After a trauma). If the analgesia is effectively tackled then, with the likes of the medications I have mentioned, and they get discharged without the need for ever escalating opioid prescriptions, how is that a bad thing? If you disagree and you think they should just get ever escalating doses of single agents then, again, that's your opinion.
As of yet there is no panacea and I doubt there ever will be. Based on your name I'm guessing that you are somehow involved in the pharmaceutical industry? If this is the case then no doubt you are aware of how difficult it is to create a drug that has decent efficacy, acceptable tolerance and safety profile and a cost efficient process of manufacturing, distribution and marketing.
I never said
berry1337 t1_j886n28 wrote
none of these treatments are effective against severe pain.
Alternative-Sea-6238 t1_j88a459 wrote
Wrong. If you have a foot amputated I can block the pain completely with a nerve block of just 20mls of local anaesthetic in the correct locations. Or I can give you ketamine and your pain is no longer an issue.
Similarly I know patients who cry out with their pains and they are on 160mg of morphine twice a day with extra opioid doses in between. Blatantly if they are crying out, the opioid are nit effective.
I've anaesthetised patients for operations, given them 20mg morphine and they are still in severe pain in recovery. Then you give them some IV paracetamol and diclofenac and the pain goes from 10/10 to them happy and chatting.
It all depends on the situation.
Steeled14 t1_j88co90 wrote
Sorry to ask so much but we’re learning lots here.
Ketamine is a new one for me in terms of chronic pain. You remain conscious, like it’s a low dose?
I’ve never done intravenous acetaminophen plus an NSAID so I could see that being much better than oral potentially.
How often can you do nerve blocks and what’s the longest they last like half a day?
Alternative-Sea-6238 t1_j88fggi wrote
Ketamine is very variable in terms of side effects depending on the doses you use. I doubt it would be good for long term use but acutely it is awesome because it remains cardiovascular stable so it's great for trauma patients who have lost loads of blood, it's a bronchodilator so it's great for asthmatics and you don't have as much respiratory/airway loss like other anaesthetic induction agents. But that is all from a general anaesthetic dosing point of view.
At lower doses I've used it for dressing changes on burns patients and for manipulating kids dislocated limbs. You give a small dose, wait for them to go into a sort of fugue state and then pop the shoulder back in.
It is associated with the potential for profound hallucinations and increased salivation though. It provides a dissociated consciousness. One patient described it as like he was watching what we were doing to him as if it was like watching a TV show. No pain at all but it didn't feel real. Some hate that feeling, some don't care.
Again though I suspect long term use, which I am not familiar with,comes with side effects and problems.
Nerve blocks can last between a few hours and a full day. Depends on what you use, where it is used and how much. But it's labour intensive. Not really something that can be done every day. Plus there is alway the risk that the needle causes damage to the nerve if the person isn't careful with it.
A few places for chronic pain give IV lidocaine infusions. You come in for a few hours, get the infusion with monitoring. Then go home the next day. Again labour intensive and so often the funding isn't available to have it in many locations.
The best therapies in terms of long term benefits are usually physiotherapy and psychology. Ultimately if a pain becomes a chronic pain, the neural pathways alter and essentially don't work how they should do. Therefore removing the pain entirely often becomes impossible and those two therapies help the most because they help the patients accept and deal with the pain so they can get on with life. Unfortunately many patients are unwilling to accept this reality and believe there is a magic cure, a silver bullet, a perfect pill that sorts everything out.
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webbitor t1_j87xdvx wrote
There's gabapentin which is decent for nerve pain.
Then there's stuff you might take for minor aches and pains; aspirin, naproxen, acetominophen, ibuprofen.
Fot severe pain, opioids are far more effective than any of those.
echoAnother t1_j87x093 wrote
Yeah, but what else, if not opioids, I'm supposed to take when I see infographics like this?
bxsephjo t1_j878n6p wrote
This has everything to do with battling the opioid epidemic. Doctors were misled and lied to by Purdue reps regarding the addictiveness of these drugs. Purdue pushed oxycodone HARD. This absolutely led to patients becoming addicted, and later overdosing. Purdue was taken to court by multiple states over this.
Sparkykc124 t1_j87b77u wrote
Eh, doctors knew, every one has known that opioids are addictive for hundreds of years. Are the Sacklers scum? You bet, but let’s not put all the blame on them. Vicodin used to be prescribed for minor injuries, as a kid I remember getting codeine cough syrup every winter, people with chronic pain were perpetually prescribed dilaudid, and somehow I’m to believe the “opioid crisis” was caused by OxyContin?
bxsephjo t1_j87c2vk wrote
Sounds like your mind is made up…
Sparkykc124 t1_j87cis9 wrote
Can you refute anything I said? Or comment on the fact that opioid deaths and use are up even though prescriptions of opioids have become almost impossible to get for the last five or so years?
Kebo94 t1_j87pbjj wrote
US consumes 80% of the worlds opiods. How is that "almost impossible".
Steeled14 t1_j87rtc9 wrote
I thought that sounded like that number made about zero sense, and I found that the “80%” figure you mentioned has been repeated all over the place and it’s incredibly false. At one point in time, at one point, the United States had 80% of world’s sales for oxycodone. 99% for hydrocodone (every other country uses different stuff like classic morphine). Careful with statistic facts and numbers out there, I tend to remind myself constantly.
Steeled14 t1_j87s2y8 wrote
Oxycodone and Purdue is a problem that definitely should be talked about but if we hyper-focus on it too much we are missing about a hundred chapters of the rest of the story. Or twenty chapters, I don’t have an exact number but you know what I’m saying.
_AlreadyTaken_ t1_j892nq3 wrote
This is addressing prescription opiates, not street drugs.
Sparkykc124 t1_j89928f wrote
I would argue that the movement to stop prescription opiates has made the opiate epidemic worse, not better, so shouldn’t be considered “combatting the opiate epidemic”.
_AlreadyTaken_ t1_j899juz wrote
It specifically says in the title "The Opioid Epidemic Medicaid's Opioid Prescription Decline" not all opiates
JustVic24 t1_j87fvzu wrote
This data talks about the decline but not the increase of death due to illegal substances being laced on the streets. Also alot of individuals now go to the ER for an injection which has driven up the cost of medicaid and insurance.
Away-Pepper-9239 OP t1_j87hute wrote
Thanks, these are the nuances that a single dataset cannot depict thoroughly
_AlreadyTaken_ t1_j892ilh wrote
This is addressing prescription opiates, not street dtugs
InternationalBand494 t1_j882x03 wrote
I have had two back surgeries and I still have occasional severe pain in my lower back. I’ll ask for 4 or 5 Vicodin to get me through until it stops hurting. Usually takes about 3 or 4 days before the pain isnt debilitating. They act like I’ve asked them for crack and sex with their SO.
fillmorecounty t1_j89v0xi wrote
It's so sad that this is what the situation has become. Doctors are afraid of prescribing strong opioids for fear of being arrested. They can be abused for sure, but for some people with the most severe pain, it's the only way they can have a quality of life. It's leading some people to end their lives and nobody cares.
varemaerke t1_j87y4un wrote
Ah great, now people with surgically fused spines and cancer pain just get told "sorry bud, you can take some Tylenol?"
But I'm sure glad no one's abusing opioids anymore!
Available_Hamster_44 t1_j87txx8 wrote
Red poppy’s are not opium poppy’s they are usually lighter in color
Matbo2210 t1_j8826fr wrote
All poppys contain opiates.
Available_Hamster_44 t1_j8829r1 wrote
But in significant numbers ?
But that would explain why people cut my poppy’s seed heads that are near a public road
Matbo2210 t1_j882d8g wrote
No you’re right that opium poppies have the highest concentration, its just that all poppies have some level of narcotics in them.
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WatercressClassic946 t1_j88fvul wrote
Cool infographic! If I were you I’d definitely avoid using old-style figures alongside capital letters. The capital M in the second paragraph sticks out like a sore thumb and honestly I can’t unsee it. You could use a small cap M to make it more comfortable to the eye.
Also that whole paragraph just repeats information that is already clearly conveyed in the graph and it feels redundant. It would be more useful to use that space to make the graph bigger or replace that text with something that tells us information that we already don’t know by looking at the graph.
Away-Pepper-9239 OP t1_j8adgvf wrote
Thanks so much for the feedback. Will look out for capital M in the future and making the first paragraph more insightful
Alternative-Sea-6238 t1_j87y3zp wrote
This is a massive topic that has began to spread. Here is the UK we are trying to get a handle on it, though the start was a bit different. Opioid drugs became licensed for use for cancer pains and were able to be prescribed.for GPs. Overtime they began to be prescribed for other pains as well and as a result many patients got put on them for pains that thy wouldn't die from.
Unfortunately one issue is the opiod addiction that resulted, but actually, two other issues compound the problem massively.
Firstly over time patients develop tolerance. That is, the body essentially gets used to the opioid dose and needs more to have he same effect. What may have started with a pain needing 30mg of codeine a couple of times a day can progress over years to the same person needing 120 mg of morphine a day. GPs just kept raising he dose because that was often a.quicker/easier action than tackling the root problem. Chronic pain clinics are underfunded, have huge waiting lists and any success from them can take.weeks/months etc from the patient's initial consultation,.compared to a 15 second.raise in.the prescription dose.
Secondly, some.patients can develop opioid induced hyperalgesia. The pain pathways alter and thr opioid itself.can stimulate it causing pain. The patient is already.addicted to the drug and at this point the pain is chronic, so explaining that they need to reduce the dose is often met with refusal and disbelief (understandably).
Opioid can be very useful in the short term but long term they can be terrible.
Away-Pepper-9239 OP t1_j870l8r wrote
This is a submission to Tableau Health Project 2023. The data source was the Medicaid prescription data from 2016 - 2020
Check out the interactive link
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bman1014 t1_j8depnq wrote
"the prescription dosage has declined by 839M" What is this metric exactly? One "suggested serving size"?
Team_Augustine t1_j87zwo5 wrote
UK here - coedine it the common drug here but hardly used in the states. How come? What is the difference
Intelligent-Fan-6364 t1_j8axbt5 wrote
Do opioids actually help with anything?
bman1014 t1_j8ddjc1 wrote
It's cultivated for a reason.
bk_cheech t1_j87sbu8 wrote
Pharmaceutical companies are the devil.
_AlreadyTaken_ t1_j892xv0 wrote
Until you need medication
LASubtle1420 t1_j87zevb wrote
Yes. And sadly the damage is already done and will be until my generation is dead and gone. The war on drugs was a disguised war on the people....and opiates were the final blow that won it. More were lost from opiate overdose in it's worst year than the AIDS epidemic lost at it's height in the 80s. Where are the protesters looking for an answer to an end. Kissinger gave a model for population control...and boy are they using it.
Sparkykc124 t1_j876her wrote
What a title! How on earth has prescribing less opioids considered “battling the opioid epidemic” when opioid use and overdoses are at all time highs?