opioids to treat infection?

[Veneficus]

So as part of today's reading, I come across information on immune modulation by opioids...

Without getting too much on the molecular details and boring you all, I would like to just put to discussion that the effects of aggresively treating pain may actually help to fight infection.

It seems in my mind, that would have considerable implications for EMS providers.

Treating something like pain from a wound to help prevent infection (by multiple mechanisms I don't want to type out) or reducing chronic infective processes in dialysis patients with post dialysis pain.

What do you think?

 

[EpiEMS]

I had thought that opioids tended to be immunosuppresive in vitro?

 

[FLdoc2011]

We already a big enough problem with opioids around here, not going to give them any more ideas.

 

[DPM]

Some advice I was given (that has also been repeated on here) was that if your body is fighting the pain then it isn't properly 'fighting' the injury. I don't know how this works for infection but analgesia aids heeling, so it makes sense to me.

 

[Veneficus]

We already a big enough problem with opioids around here, not going to give them any more ideas.

In my experience, US EMS does not do enough to mitigate pain.

But I have to say, I find it quite ironic when providers rally against opioid abuse. I think it is more of a moral/social issue than a medical one.

If an alcoholic comes in with DT, what is the treatment? Would you not be remiss for not giving them alcohol?

If somebody on THC comes in with the same do they not get benzos?

nobody rallies against overpresciption or usuage of psychoactive agents, those are adverted on TV. Ask your doctor now! Call us for this free information packet on what to say so if he doesn't prescribe them he is negligent.

I used the example of chronic pain with dialysis. If a patient has a medical condition that is largely palliative, does it matter if they are addicted to opioids too?

If you are palliating a terminal untreatable illness, isn't benzos and opioids the way to go?

If you are going to try to solve social issues like addiction with medicine, which cannot possibly address the root cause, what makes palliation such a undesirable alternative?

Is there more than a moral dfference between paxil and morphine?

Inquiring minds want to know.

 

[FLdoc2011]

I was kind of being tongue in cheek, but I also will rally against providers. We have one of the worst areas in the country In regards to opioid abuse here and I see a LOT of the complications from such use.... OD, septic from IV use, endocarditis/ruptured valves, etc...

Of course I'd treat DT with benzos, benzo withdrawal can kill. Opioid withdrawal is not fun but not going to kill you for the most part. If someone is already on an established pain med regimen and it's documented then I'll continue that, I'm not here to detox someone. But my issue is the pt with vague pain admitted with no obvious pain demanding IV dilaudid because that's what they got in the ED.

And of course I'm not talking about pts with cancer or honest to goodness real chronic pain. I won't get into fibro or chronic back pain, but I will admit there is also a huge problem with shady providers who will provide these pts with any narcotic they request and while it may be "legit" and prescribed, it's bad medicine and setting these people up for problems. Then they get some benzos added for anxiety and it's a deadly combo.

Also do some work for the VA and its been a big push recently in getting people off benzo/opioid combos and actually being limited what we can even write for and I agree.

 

[Veneficus]

We have one of the worst areas in the country In regards to opioid abuse here and I see a LOT of the complications from such use.....

C'mon you can't leave it at that... Why?

But my issue is the pt with vague pain admitted with no obvious pain demanding IV dilaudid because that's what they got in the ED.

I think I would find that antagonizing as well.

but I will admit there is also a huge problem with shady providers who will provide these pts with any narcotic they request and while it may be "legit" and prescribed, it's bad medicine and setting these people up for problems. Then they get some benzos added for anxiety and it's a deadly combo.

Do you find many of these people already have unresolved social problems to begin with?

It has been my observation that most addicts usually do.

its been a big push recently in getting people off benzo/opioid combos and actually being limited what we can even write for and I agree.

I always find it undesirale to limit treatment options. A resolution to get people off of medications is a good idea, but I have to ask, what are you sending these people back to?

Are they capable of re-entering society as producers?

If yes, it is obviously a logical choice. If no, what is the endgame?

 

[firetender]

Some advice I was given (that has also been repeated on here) was that if your body is fighting the pain then it isn't properly 'fighting' the injury. I don't know how this works for infection but analgesia aids heeling, so it makes sense to me.

I don't see any problem with it as infection is typically a transient state -- as is pain. So I could see including it in aggressive treatment of infection.

This kind of goes along with slowing down the body so its defenses can gather to open the door to healing, basically taking the patient out of the "fight" and into natural mobilization.

Infected addicts get a free, theraputic ride and I don't see this approach as something that would "create" addicts.

 

[Aprz]

All I could find on Google was that chronic use of opioids may decrease perioperative infection, but when used acutely, increase likeliness of infection. I didn't immediately find anything of why nor can I think of a reason. Do you have any recommended reading material on this subject?

 

[Veneficus]

I just found the mechanism in a surgery text, they cited some sources, but I didn't check it out.

 

[Aprz]

How does opiates (like morphine) even work? They mimic endorphins or cause endorphins to be released?

 

[Veneficus]

How does opiates (like morphine) even work? They mimic endorphins or cause endorphins to be released?

They mimic endorphines, attaching to the same receptors.

Which happen to also be found on various immunogenic cells like lymphocytes and macrophages.