It is no longer possible to simply continue previous practices with respect to the management of chronic pain. The associated risks of opioid diversion, overdose, and addiction demand change. Although there are no simple solutions, we recommend three practice and policy changes that can reduce abuse-related risks and improve the treatment of chronic pain in northeast PA and throughout the US. Opioid rehab is on the rise and we are looking at the root causes of opioid abuse to find answers.
INCREASED USE OF SCIENCE-SUPPORTED PRESCRIBING AND MANAGEMENT PRACTICES
The extended prescription of opioids (>8 weeks) for the treatment of chronic pain has questionable benefits for individual patients and presents substantial public health risks. The risks of overdose and addiction from this prescribing practice — both among patients with chronic pain and the public at large — increase with higher doses (>100 MME), longer duration of prescribing, and perhaps the use of long-acting opioids. Despite these facts, a Medicaid study showed that more than 50% of opioid prescriptions were for doses higher than 90 MME and for periods of more than 6 months. Better results can be obtained by using the most contemporary guidelines for pain management.
INCREASED MEDICAL SCHOOL TRAINING ON PAIN AND ADDICTION
Very few medical schools offer adequate training in pain management, and still, fewer offer even one course in addiction. The result is that even experienced clinicians are unsure about how to deal with fundamental and omnipresent clinical issues in their practices. Many motivated, well-intentioned physicians do not know whether to prescribe opioids for pain management and, if so, which ones and for how long. Still fewer understand the pharmacologic or clinical relationships among tolerance, physical dependence, and addiction. This education is particularly critical for primary care practitioners, who prescribe more than 70% of opioid analgesics.
INCREASED RESEARCH ON PAIN
At a recent workshop at the National Institutes of Health on the role of opioids in the treatment of chronic pain, attendants recommended several areas of research that are needed for improved clinical practice guidelines. These areas included how to differentiate the unique properties of acute and chronic pain and how to describe the process by which acute pain transitions into chronic pain. Discovery-oriented research was also recommended to identify new, potent nonopioid analgesics and other pain-treatment strategies. Access to biomarkers of pain and analgesia that take advantage of neuroimaging technologies or genetic analyses would accelerate the development of new medications and allow for more personalized clinical interventions for pain management.
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