Here is an example of complexity gone amok!

[Guest guest]

Well, fellow travelers, I was reading this study about opioid use

before and after pancreatic resection (meaning after they cut the

hell out of your pancreas! LOL). Here is an abstraxt of a study and I

will give you MY summation at the end:

Influence of opioid use on surgical and long-term outcome after

resection for chronic pancreatitis.

akis N, Connor S, Ghaneh P, Raraty M, Lombard M, Smart H,

J, M, Garvey CJ, Goulden M, C, Sutton R, Neoptolemos JP.

Department of Surgery, Royal Liverpool University Hospital,

Liverpool, UK.

BACKGROUND: The outcome of pancreatic resection for chronic

pancreatitis in patients with preoperative opioid use is not well

described. METHODS: During 1997 to 2003, 112 of 231 patients referred

with chronic pancreatitis underwent pancreatic resection. The outcome

of patients who had preoperative opioid use (N=46) was compared with

those without (N=66). RESULTS: Patients who used opioids presented at

a younger age and had a younger age of symptom onset, longer symptom

duration, more hospitalizations, a higher frequency of diabetes

mellitus, a higher pain score, and more restriction in daily activity

(all P<.05). Twenty-one (46%) patients with opioid use had a total

pancreatectomy compared with 9 (14%) without opioid use (P=.0002);

the 21 patients also had a higher frequency of postoperative bleeding

and early reoperation (8 vs 2, P<.02; 11 vs 3, P=.003, respectively).

Mortality and overall morbidity was not significantly different

between the 2 groups (4 vs 1, 27 vs 34, respectively). Pain scores

improved postoperatively in both groups (P=.001) and was not

significantly different between the groups from 12 months onward

(median follow-up of 12 months, range, 3-60 months). Twenty percent

of patients who used preoperative opioids however reverted to

morphine use compared with 6% of patients who had not used opioids.

CONCLUSIONS: Patients who used opioids had more advanced disease than

patients without opioid use, accounting for part of the postoperative

morbidity. Although long-term pain relief was comparable between the

2 groups, maintaining opioid withdrawal was more problematic in those

with preoperative opioid use. Earlier referral for resection may be

warranted in this group of patients.

What this means is: operate earlier on really sick pancreatic

patients so that you don't have to give them opioids so long before

you do the surgery!!!! THAT'S IT!

Anyse

[Guest guest]

Hi Anyse,

I have often run into this same outlook when I research the

various treatments involved with CP. It seems that surgeons,

especially, are more " negative " towards opiod use. In fact, one

website for an university hospital (I think) mentioned in no

uncertain terms that surgery is warranted on all patients that

need narcotics for pain control more than the standard 10 days a

year. They then go on to say that pain relief as a result of the

various surgeries is not sustained or is not significant.....but hey,

they did their moral best to not have the patient on opiods! I see

this as medical blackmail and i have no respect for this opinion

or outlook. Mainly because it is due to some artificial " morality "

of our society. You wouldn't run into this attitude if the surgeons

were discussing other medical problems such as heart

disease. It is a rare cardiac surgeon who would go straight to

the heart transplant surgery just to avoid prescribing blood

pressure pills or statins, for example.

I just see red when I read articles like the one you

referenced....and these are not that uncommon. I could give you

many conclusions or opinions that reflect this belief.

Another thing to keep in mind too though, is that from a

surgeon's perspective, the only way to treat a patient is to hack

something out (or physically reconstruct it). So they are skewed

in their outlook....leaning towards doing an instant fix. So that is

part of the reason for the surgery recommendation rather than

treating something with medicine.

The fault that I see in all of these papers from a logical point is

that they never speculate or offer learned opinions about why the

use of narcotics is a predictor for unfavorable outcomes based

solely on the physical properties of the drugs. They seem to

concentrate on the social aspects but fail to address what it is in

the chemical make-up of the drugs that may hinder healing or

recovery. Is it that they suppress the immune system? Do they

induce lethargy somehow delaying tissue regeneration? Not

that I say any of these things happen, but these would be the

type of questions to ask. Speculation that infers that there is a

" character flaw " in people who resort to long term use of opiods

for pain relief in CP is inherent in the way conclusions like these

are written.

I would think that if anything. their research may lead them to

believe that use of narcotics is one sign that the disease is

present in a more serious form. And use this information as a

way to determine diagnosis and treatment. This could spur

them into finding a more reliable means of diagnosing and

treating CP before it gets to the stage when people need

everyday doses of narcotics. I sure wouldn't evaluate narcotic

use as THE indicator that surgery is needed...especially when

surgerical treatment of the pancreas is such an iffy process.

And.....why should withdrawal of opiod use be the endpoint to

determine the success of surgery? If the goal is to " cure " pain

only, then why isn't eliminating pain by the use of narcotics not

MORE acceptable than hacking away at the body, which risks

inducing long term pain from the procedure itself. If surgeons

truly believe that there are no long-term ramifications on the body

of the act of surgery itself, then they are delusional. I don't care

how good a surgeon they are.....there is no way to prevent

trauma to the muscles and nerves and other components of the

body when you cut into them and you inevitably end up with

chronic pain from any surgery: Some negligible, other types quite

significant. So why do a procedure that will cause new pain (or

add to existing pain) just on the off chance that you will get rid of

pain? It is circular and unreasonable logic (if there is other

reasons for the surgery though, then it IS reasonable to do it,

don't get me wrong). The other thing that I would suggest, as a

patient, is that maybe those of us who use opiods before the

surgery are just so sick of feeling pain, and have an

uderstanding of how life-sustaining pain control is, that we have

no intention of " biting the bullet " just to satisfy society's moral

code. I know that I sure wouldn't............and if that is

" dependence " or " addiction " then so be it. It is as ridiculous to

deny us the medicine that makes us able to live life as it is to

deny the diabetic insulin or the asthmatic his inhaler.

Your conclusion by reading between the lines, is quite accurate I

think. These morans are kow-towing to the so-called morality of

our society. Just like the german scientists who published

papers in the 1930s " proving " that aryans are the master race.

Science is not " pure " or as objective as most people think...there

is always a political motive behind the studies.....how they are

designed, what is studied, what the aims are and how the

conclusions are stated.

just my humble but cynical opinion.

laurie