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FEW PEOPLE WITH SEVERE HEADACHES BENEFIT FROM NARCOTICS
MONTREAL -- Daily narcotic pain medications may not help most people with persistent difficult-to-treat headaches, suggests a prospective 5-year study being presented in a special session here at the 42nd Annual Scientific Meeting of the American Headache Society (AHS).
In recent years, it has become more acceptable to prescribe narcotics to patients with difficult-to-treat pain. While prescribing narcotics to some people may be very appropriate, particularly those who are terminally ill or those with cancer-related pain, it may not be the best option for most people with difficult-to-treat and recurring headache. The study found less than a quarter of people with severe chronic headaches benefitted from the narcotics.
"There is definitely a place for daily narcotics in treating some headache patients," said Joel R. Saper, M.D., director of the Michigan Head-Pain & Neurological Institute, Ann Arbor, and clinical professor of neurology at Michigan State University, E. Lansing, Mich. "In fact, in some instances, the appropriate use of narcotics has given even the most desperate patients their lives back and allowed totally impaired and disabled people to become highly productive and almost pain-free. However, before we aggressively prescribe these potentially dangerous medicines to more and more patients with difficult headache problems, we must first establish proper guidelines for prescribing narcotics and develop standards to appropriately monitor treatment and patients' use of the drugs.
"During the past several years at our center, we have evaluated an increasingly large number of headache patients who have been prescribed daily narcotic treatment, often in self- injected forms, long before more appropriate treatments were tried," said Dr. Saper.
The study shows that approximately one-quarter of those prescribed narcotics benefitted from taking the medications daily (or regularly), while some people's headaches actually appeared to get worse. By two months of treatment, researchers frequently were able to predict whether the treatment would be effective over the next three to five years.
The prospective study followed 386 people, most of whom suffer from chronic daily headache, who had come to the Michigan Head-Pain & Neurological Institute after all other medications and treatments for their headaches had failed to bring satisfactory relief. They were included in the study only after a variety of advanced treatments prescribed by the Institute's physicians and hospitalization in a special hospital unit also failed to alleviate the pain. In the study, 24 percent of the patients obtained significant relief with narcotics and remained on the drugs for three years or longer. Of that group, 1 in 10 patients exhibited inappropriate drug- taking behavior, including violating dosage levels, claiming that prescriptions for narcotics had been lost and obtaining narcotics from other sources.
The study was highly controlled, requiring patients to have monthly visits with an Institute physician and regular psychological visits as well. Each patient signed a treatment and compliance contract before entering into the study. In a less-controlled setting, there might be more violations than those seen in the study, said Dr. Saper.
"There is unquestionably a place for narcotics in the treatment of some headache patients, and inappropriate denial of their use is unacceptable," said Dr. Saper. "We are hopeful our experience with this very difficult-to-treat group of people will lead to the development of appropriate treatment guidelines and protocols that might increase the chances of making narcotics available to all those who would benefit from them, but not to those for whom they may be harmful."
Co-authors of a paper on the topic being presented at the meeting by Dr. Saper are: Alvin E. Lake, Ph.D.; Robert Hamel, P.A.; Tom Lutz, B.A.; Dottie Sims, R.N.; Barbaranne Branca, Ph.D.; Mary Kroll, R.N.; and Linda Gram, R.N.
The American Headache Society (AHS), founded in 1959 as the American Association for the Study of Headache, is based in Mt. Royal, N.J. AHS is a professional organization for those interested in the study and management of headache and face pain. AHS has approximately 1,500 members. For more information, visit the AHS Web site at http://www.ahsnet.org. To fill the need for patient education, AHS established the American Council for Headache Education (ACHE), a non-profit patient-physician organization for the advancement of the treatment and management of headache and the encouragement of more constructive social attitudes towards the disease. Individuals who would like more information about headache, who would like a referral to a specialist who treats headache, or who would like information on support groups can call (800) 255-ACHE, write to ACHE at 19 Mantua Road, Mt. Royal, N.J. 08061 or visit the ACHE Web site at http://www.achenet.org.
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Editor's note: Study numbers are current as of June 12, and may change.
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