Imagine you’re in your late 50’s and you’ve had a wildly successful research career. You wrote a revolutionary study at age 31, and most major players in the field would become your disciples. Your work has changed the daily lives of millions of people — whether they’re happy or sad, getting better or worse, alive or dead. And now imagine that you’ve come to realize that much of what you’ve taught is wrong. What do you do next?
You prepare for the revolution.
Meet Russell K. Portenoy, M.D., (profiled in Saturday’s WSJ) who pioneered long-term prescription of opioid drugs for chronic non-cancer pain.
Now, Dr. Portenoy and other pain doctors who promoted the drugs say they erred by overstating the drugs’ benefits and glossing over risks. “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation? Well, against the standards of 2012, I guess I did,” Dr. Portenoy said in an interview with The Wall Street Journal. “We didn’t know then what we know now.”
Recent research suggests a significantly higher risk of addiction than previously thought, and questions whether opioids are effective against long-term chronic pain.
Some further reading suggests that randomized trial evidence of efficacy does appear to be weak. Meanwhile, the evidence of harm will continue to mount. Turns out, there doesn’t appear to have been much of a basis for the spread of the idea in the first place.
In lectures he [Dr. Portenoy] cited the statistic that less than 1% of opioid users became addicted. The figure came from a single-paragraph report in the New England Journal of Medicine in 1980 describing hospitalized patients briefly given opioids. Dr. Portenoy now says he shouldn’t have used the information in lectures because it wasn’t relevant for patients with chronic noncancer pain.
Pain management would appear to be ripe for a different idea.