NIH. US: 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.
“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,” stated Dr. Reuben. “The
challenge is to identify the conditions for which opioid use is most
appropriate, the alternatives for those who are unlikely to benefit
from opioids, and the best approach to ensuring that every patient’s
individual needs are met by a patient-centered health care system.”
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,” noted
Dr. Reuben.
To address knowledge gaps, the panel cited a need for
more research on pain, multidisciplinary pain interventions, the
long-term effectiveness and safety of opioids, as well as optimal
opioid management and risk mitigation strategies. However, because
well-designed longitudinal studies can be large, expensive, and
difficult for recruitment, the panel encouraged the development of new
research design and analytic methods to answer important research and
clinical questions.
The panel also recommended engaging electronic health
record vendors and health systems to provide pain management decision
support tools for clinicians. In addition, the panel advised the NIH
and other federal agencies to sponsor more conferences to harmonize
pain assessment and treatment guidelines to facilitate consistent
clinical care for the treatment of 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) 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. Audio playback will be available
shortly after the conclusion of the telebriefing and can be accessed by
calling 888-640-7743 (United States and Canada) or 754-333-7735 (other
international callers) and entering replay code 114001.
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 final report, which
identifies future research and clinical priorities, incorporates the
panel’s assessment of an evidence report, expert presentations,
audience input, and public comments. 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 workshop was co-sponsored by the NIH Pain
Consortium, the National Institute on Drug Abuse (NIDA), and the
National Institute of Neurological Disorders and Stroke (NINDS). The
evidence report was prepared by the Pacific Northwest Evidence-based
Practice Center through the Agency for Healthcare Research and
Quality’s Evidence-based Practice Centers Program.
The seven-member panel included experts in the fields of
gerontology, rheumatology, internal medicine, psychiatry, addiction
medicine, nursing, health education, biostatistics, and epidemiology.
Panel member biographies, an archived videocast of the workshop, and
additional resources are available at https://prevention.nih.gov/programs-events/pathways-to-prevention/recent-workshop/opioids-chronic-pain. Interviews with panel members can be arranged by contacting Deborah Langer at 301-443-4569 or langerdh@od.nih.gov.
The ODP assesses, facilitates, and stimulates research
in health promotion and disease prevention in collaboration with the
NIH and other public and private partners, and disseminates the results
of this research to improve public health. For more information about
the ODP, visit http://prevention.nih.gov.
The NIH Pain Consortium was established to enhance pain
research and promote collaboration among researchers across the many
NIH Institutes and Centers that have programs and activities addressing
pain.
NIDA’s mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction.
The mission of the NINDS is to seek fundamental knowledge
about the brain and nervous system and to use that knowledge to reduce
the burden of neurological disease.