Chronic Pain - Adjunct Therapy regimine takes a hit
We might wonder what goes on in the minds of the doctors prescribing Celebrex, because they are a crucial link in the drug chain.
Are they aware of the controversy or the news?
Where do they get their information from?
Are they intimidated by the College of Physicians and Surgeons to the point where they would have to balance patient safety with trying to keep their job?
First, some background -
A few years ago the medical Colleges were notifying doctors of a new regimine of drug treatment for chronic pain patients who are taking opiod painkillers such as morphine. Called "adjunct therapy", or the "multimodal approach to chronic pain", this approach involves using anti-inflammatory drugs, anti-depressant drugs, muscle relaxants, and other drugs such as Lyrica in chronic pain patients.
The idea is that it would provide a broader approach to pain relief in these patients, and it would help the morphine work better which would in turn help avoid increases of the morphine as tolerance develops.
I think the whole idea of adjunct therapy is pure hooey, just a way to sell more drugs for the PharmaGiants. The patient's well being, and some of their concerns, are ignored.
The rationale doesn't even make a lot of sense - morphine is the most powerfull and effective of all those drugs, and so taking a weaker drug will not have any benefits, but all the side effects of the "adjuncts" will have to be endured by the patient.
One part of the reasoning in the multimodal approach is to prescribe anti-inflammatory drugs, because anti-inflammation is something morphine does not do. That only makes sense if the chronic pain patient has inflammation, and many of them do not. For example, one of the most common illnesses of the chronic pain group is Fibromyalgia where muscles cramp, twitch, ache, fatigue easily... but there is often no inflammation. This is my personal experience, as it is with the other "Fibros" I know personally - no inflammation. [admittedly, "chronic pain" can mean many things, it is not only Fibromyalgia]
Antidepressants often have debilitating side effects, and chronic pain patients are generally more sensitive to almost everything - the basis of their illness is sometimes called "hyper sensitivity" where very little discomforts are felt as strong pains - and sure enough we find that Fibros do not tolerate the anti depressant drugs very well. "Feeling like a dishrag all day" is not an improvement on their quality of life. There is no pain reduction from anti depressants when a muscle is in a full blown cramp!!
SO ANYHOW, now there is some NEWS: Dr. Reuben, the lead author of the study that was used to approve Celebrex was found guilty of fraud this week. It was discovered that he never enrolled ANY patients in those studies, he simply wrote it up in his spare time. He told the PharmaGiants only what they wanted to hear, that Celebrex worked well and was completely safe.
NOW the whole "adjunct therapy" , or "multimodal approach to chronic pain" idea should be reconsidered.
Why? - this same Doctor, Dr. Reuben, was the lead author of the study for the multimodal approach to chronic pain. The FDA and the Colleges and the drug companies were all quoting Dr. Reuben, relying on his findings to justify the multimodal approach.
I wonder if my doctor has heard about this... I wonder if I will get into trouble for posting this?