More needs to be done to understand how best to treat the 100 million Americans living with chronic pain, finds a new report from a panel convened by the National Institutes of Health (NIH). “The societal costs of chronic pain are estimated at between $560 and $630 billion per year as a result of missed work days and medical expenses,” the report stated.
NIH convened the “Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain” in September 2014 to assess the long-term effectiveness of opioids, the safety and harm of these medications, the effectiveness of different opioid management strategies, and the effectiveness of risk mitigation strategies for opioid treatment. The panel’s conclusions, along with an evidence report, were published in January in Annals of Internal Medicine.
The panel found that there is insufficient clinical research to show doctors how best to treat adults with chronic pain, noting that many patients have multiple health issues. "Ten years ago, the medical community spoke of pain as the fifth vital sign," said panel member Christopher Callahan, MD, founding director of the Indiana University Center for Aging Research and Regenstrief Institute investigator, in a prepared statement. "Even though we know that treatment should be tailored to individual patients, there is no existing algorithm that helps researchers or clinicians determine which patients with which type of pain should be treated with which available approach.”
Also, while many chronic pain patients take opioids, there are no guidelines to assess and treat their pain. “Although numerous treatments are available for treatment of chronic pain, an estimated 5 to 8 million Americans use opioids for long-term management of chronic pain. Moreover, workshop speakers presented data from numerous sources that indicate a dramatic increase in opioid
prescriptions and use over the past 20 years,” according to the report.
For example, there were 76 million prescriptions for opioids written in 1991, compared to 219 million in 2011, yet 40% to 70% of those living with chronic pain do not receive proper medical treatment—referring to both over- and under-treatment of their pain.
“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” according to the report. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”
Still, with little research to go on, the panel discussed how doctors can handle prescribing pain medications for patients for whom such drugs are appropriate. "The panel did hear suggestions of what providers might do in the face of the limited available evidence,” Callahan explained. “For example, physicians might prescribe smaller quantities of opioids. This could potentially require individuals in pain to travel more frequently for prescription refills, but it would also decrease the amount of drugs potentially available to abusers.”
In addition, doctors should educate their patients about concerns that anyone with access to pain medications could abuse them. "In educating their patients, providers might also tip the balance of their cautions about these drugs to highlight that they are important drugs with important dangers to both the patient and those who might obtain them accidentally or illegally,” Callahan explained in the statement. “At the same time, the panel heard testimony that patients who responsibly use these medications should not be treated like criminals."
Callahan is calling for funding clinical trials “designed with input from both patients and those who treat pain,” according to a press release. Read the entire report online.