I don't understand how could be possible to include patients already on opioids in a randomized trial of opioid vs nonopioid analgesics. You would have seen a number of withdrawal syndromes and consequent dropouts. Couldn't be done. The argument isn't valid.
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The study design in itself is not the flaw, the flaw is the failure to report that the results are only valid for patients for whom opioids are not indicated, not for those for whom they proved to be useful.
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Interesting, I’ve wondered about this.
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I have a neurosurgeon friend who argues opioid (over)use arose from anti-pain trends in the medical community many years ago, e.g., "no one should have to suffer pain given pain management meds available today." Hadn't heard that argument before, but certainly seems plausible.
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