Need for individualized, patient-centered approach to pain

NIH Panel cites need for individualized, patient-centered approach to treat and monitor chronic pain

An independent panel convened by the National Institutes of Health concluded that individualized, patient-centered care is needed to treat and monitor the estimated 100 million Americans living with chronic pain.

The panel will hold a press telebriefing on Friday, Jan. 16, at 3 p.m. EST to discuss its findings with members of the media. To participate, call 888-428-7458 (toll free for United States and Canada)

“Persons living with chronic pain have often been grouped into a single category, and treatment approaches have been generalized with little evidence to support this practice,” said Dr. David B. Reuben, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “Chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, multifaceted approach.”

Chronic pain is often treated with prescription opioids, but the panel noted widespread concern with this practice. Although some patients benefit from such treatment, there are no long-term studies on the effectiveness of opioids related to pain, function, or quality of life. There is not enough research on the long-term safety of opioid use. However, there are well-documented potential adverse outcomes, including substantial side effects (e.g., nausea, mental clouding, respiratory depression), physical dependence, and overdose—with approximately 17,000 opioid-related overdose deaths reported in 2011.

Just for perspective: “Medical error is now the third leading cause of death in the U.S.: Some 440,000 deaths a year are caused by hospital mistakes, and who knows how many more from outpatient mistakes.” (http://www.kevinmd.com/blog/2014/12/medical-errors-cant-trust-doctors-get-right.html)

“Clearly, there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches,”

Kudos to this panel for daring to speak the truth: for many of us, opiates provide our only possible relief, and taking them away results only in misery and declining health.

The panel identified several barriers to implementing evidence-based, patient-centered care. For example,

  • many clinicians do not have tools to assess patient measures of pain, quality of life, and adverse outcomes.
  • Primary care practices often do not have access to multidisciplinary experts, such as pain management specialists.
  • Insurance plans may not cover team-based, integrative approaches that promote comprehensive, holistic care.
  • In addition, some plans do not offer effective non-opioid drugs as first-line treatment for chronic pain, thus limiting a clinician’s ability to explore other avenues of treatment.
  • Once a health provider has made the decision to use opioids, there are insufficient data on drug characteristics, dosing strategies, or tapering to effectively guide clinical care.

“We have inadequate knowledge about treating various types of pain and how to balance effectiveness with potential harms. We also have a dysfunctional health care delivery system that promotes the easiest rather than the best approach to addressing pain,”

The panel will hold a press telebriefing on Friday, Jan. 16, at 3 p.m. EST to discuss its findings with members of the media. To participate, call 888-428-7458 (toll free for United States and Canada) or 862-255-5398 (toll for other international callers) and reference the NIH Pathways to Prevention program on The Role of Opioids in the Treatment of Chronic Pain.

To better understand the role of opioids in the treatment of chronic pain, the NIH Office of Disease Prevention (ODP) convened a Pathways to Prevention workshop on Sept. 29–30, 2014, to assess the available scientific evidence

The panel’s report, which is an independent report and not a policy statement of the NIH or the federal government, is now available at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources

The seven-member panel included experts in the fields of gerontology, rheumatology, internal medicine, psychiatry, addiction medicine, nursing, health education, biostatistics, and epidemiology.

2 thoughts on “Need for individualized, patient-centered approach to pain

  1. Judith Bruno

    Again I will ask: Please start asking some real questions like are any real drug addicts no longer abusing drugs with these policies because we know that Prohibition does not work?If you take away a drug addicts drug of choice, in this case pills, they will turn to whatever they can find. Those are fact! The country is so concerned over the raise in heroin addiction and you will find, that the raise is directly connected to these policies as they will and are turning to heroin and now our government is supporting the Drug Cartels who will get a drug addict anything they want just as the “Mob’s” did for alcohol. Did we learn nothing from history?

    Why is the life of a drug addict more important than the lives of those who are in pain? This is about quality of life, a life that is worth living. Suicides are on the raise and will continue when that life is not worth living.

    Why are politicians acting as doctors in the decisions of what is the best way to treat us?

    Mothers can no longer care for their children and bread winners no longer able to support their families. Who is going to pay for that care and where will that money come from? Who is going to care for those like myself who strive to stay independent and live within the boundaries of our disabilities but can no longer do so without the pain relief we need?

    Health Care in this country is going to fail under these policies and it must when doctors refuse to take on patients who are in pain, clinic are closing and good doctors can no longer treat their patients in the way they know is best without fear of prosecution? Who are they going to blame for this? Obama Care? Someone must be blamed for the failure of our health care system to deal with those who are in pain.

    Chronic Pain is a disability and we are being discriminated against because of those who will and do abuse drugs just like any religion or race who is discriminated against because of the actions of a few. We need someone to stand for us, talk about us, do something for us in this losing war on drugs.

    We are told that 13% of Veteran’s abuse drugs but what about the 87% who need relief from pain and now can’t get that relief? Chronic Pain can and does kill and those who can no longer deal with a life in pain 24/7 will take their own lives and Veterans are the most vulnerable after the horrors of war. America makes these Veterans and makes the pain they now live with and yet we are turning our backs on them and telling them there is nothing we can do for the pain they are in.

    Why aren’t pain patients given the same rights as others to decide what is the best care for their problems? Politics needs to stay out of our relationship between our doctors and the care we need.

    Please do your jobs, do it right, look into the problems these policies are making that no one will talk about because of the fear of supporting drug addicts but we are NOT drug addicts, we are patients who need help.

    Please look into the politics of all of this as we know the reasons behind this attack on pain medications after losing the war on Marijuana, which will become legal in this country, in order to validate their existence and the billions of dollars wasted in this losing war on drugs are now attacking those who are in pain. Look into the big pharmacies and the fight against them and yes, they need to be held responsible for never finding cures but only drugs that mask the symptoms to make more money but taking all of this out on those who’s only sin is that they are in pain, is not the right way to fight any of these injustices.

    Please, think of the quality of life of those who are suffering in pain and think of your families, your parents, your children and how you would feel if they were suffering in pain and told there is nothing that can be done.

    Help us, help the millions of American’s both Veterans and civilians alike who are actually being tortured because of these policies. Please look at all sides of this war on drugs and the dangers of drug abuse but remember, there are millions of us who need relief from our pain. They can’t fix the problems, can’t give us what we need to live with any kind of quality of life without the pain medications that are available so why are they torturing us?

    Liked by 1 person

    Reply

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.