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.