CDC Advises Nonopioid Treatments for Chronic Pain

Marta Pagán-Ortiz
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Primary care clinicians and mental health providers face a particular set of challenges when treating individuals with chronic pain. These problems are compounded by concerns regarding medication efficacy and misuse, as well as a feeling among clinicians that they lack appropriate training. The Center for Disease Control & Prevention’s Guideline for Prescribing Opioids for Chronic Pain was published in March with the goal of improving communication “between providers and patients about the risks and benefits of opioid therapy for chronic pain…” The authors conclude the report with twelve recommendations, the first being to avoid using opioid therapy as the first line of treatment for chronic pain, as well as discussing the risks of long-term opioid therapy.

“Opioids should not be considered first-line or routine therapy for chronic pain outside of active cancer, palliative, and end-of-life care, given small to moderate short-term benefits, uncertain long-term benefits, and potential for serious harms; although evidence on long-term benefits of nonopioid therapies is also limited, these therapies are also associated with short-term benefits, and risks are much lower.”

Opioid medication is associated with serious risks including clinically significant impairments, dependence, and overdose. Despite these risks, primary care clinicians often prescribe opioids for pain, which is particularly problematic as the prevalence of chronic pain amongst adults in the U.S. is increasing, including upwards of 25 million people.

According to a recent study, physicians in primary care are concerned “about opioid pain medication misuse, find managing patients with chronic pain stressful, express concern about patient addiction, and report insufficient training in prescribing opioids.”

Photo credit: Nick Webb, FFlickr
Photo credit: Nick Webb, Flickr

The review process for the latest CDC report was extensive and included an update of a 2014 systematic review on the effectiveness and risks of opioids; the use of a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to evaluate, assess, and grade evidence; and the input from a number of informants including experts, peer reviewers, and the public. The guidelines are intended for individuals with chronic pain – not in active cancer treatment, palliative, or end-of-life care.

The review found no evidence for “a long-term benefit of opioids in pain and function vs. no opioids for chronic pain with outcomes examined at least one year later (with most placebo-controlled randomized clinical trials ≤6 weeks in duration).” The researchers also found:

– Extensive evidence shows the possible harms of opioids (including opioid use disorder, overdose, and motor vehicle injury).

– Extensive evidence suggests some benefits of nonpharmacologic and nonopioid pharmacologic therapy, with less harm.

The results are divided into three areas: determining when to use opioids; opioid selection and discontinuation; and risk and harm assessment. The first of twelve recommendations state:

“Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if the expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.”

These guidelines, which explicitly discourage physicians from indiscriminately prescribing opioids, along with other studies regarding alternative treatments for pain conditions, are the first steps toward the adoption of more comprehensive treatment plans for those experiencing chronic pain.

 

View the CDC Guideline for Prescribing Opioids for Chronic Pain Factsheet here→

September is Pain Awareness Month. Learn more about how to raise awareness around issues of pain management here→

 

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Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain – the United States, 2016. Journal of the American Medical Association, 315(15), 1624-1645. (Abstract)

11 COMMENTS

  1. –sigh–

    I’m concerned that this sort of Puritanical approach might deprive many people of effective care for their pain problems. Plus, a lot of medical “knowledge” seems to be dogma and ideology, not…I dunno…science. In the 50s, docs were so anti-pain killers (but they were cool with uppers and downers, btw) that they’d lobotomize people in severe pain. I seem to recall seeing a couple old Thorazine ads promoting the drug for cancer patients. And then…there’s the industry $$$ to consider…

    It seems that Big Pharma has milked about all the $$$ it can out of pain management with potentially fun drugs, so…time to move on. I guess all the patents on the fancy new “non-abusable” pain killers have expired?

    • We’ve got a problem when it comes to deaths due to mixing opioids with other drugs. I see this as a very promising move on the part of the CDC. I don’t know if it will save lives, but that, I would imagine, is the intent. The alternative would be even more loss of life, and a worsening situation all the way round.

    • It was a “safe pain killer,” actual “dirty” opioid, mixed with a “safe smoking cessation drug,” actual mind altering antidepressant and a NSAI that resulted in my “bipolar” misdiagnosis. It’s a shame today’s medical and psychiatric communities are completely unaware of the fact that opioids are mind altering, dangerous, and addictive drugs. Wouldn’t this qualify today’s medical community as “delusional”?

      I do, at a minimum, think the mainstream medical community should be legally required to honestly inform people, prior to prescribing ANY mind altering drugs.

  2. I agree; I saw this *a lot* when I worked in a Community Clinic(™)…They now require drug tests before renewing existing ‘scripts, humiliating already compliant patients in genuine need of relief from chronic, debilitating pain. My neighbor needs medical care but now refuses to go to the clinic for her *heart meds* cuz they now require her to submit to drug testing.

    ‘Modern Medicine'(™ again) proved to be so barbaric in my mind that I can no longer in all good conscious, work in that field. *RIght Livelyhood* and all that…

  3. Many people have chronic pain, a few become addicted to opiate pain medication.

    Spock says, “Logic clearly dictates that the needs of the many outweigh the needs of the few.”

    I am not buying into this drug war propaganda, oh ya sure the government “cares” if you become addicted that must be why if they catch you with drugs they put you in jail and then enrich themselves with fines fees and court costs to pay for all those luxury cars in the employee parking lots of those court buildings they drive home to their Mc mansions in the suburbs full of toys.

    They “care” about you. Keep believing the propaganda.

  4. The addiction to pain pills is out of control.

    In the city that I used to live in people would come to my front door peddling hydros and oxycontine! This one particular person would get them from their brother, who got them from the VA every month. When he got his prescriptions filled he’d send his sister out to peddle them from door to door in the neighborhood. I realize that many people suffer from horrific physical pain but when you see what I saw out on the streets where I lived you know that something has gone terribly wrong and that something must be done.

    • If someone offers you some pills just don’t buy them.

      “Something must be done” Sounds great until you realize all they know how to do is turn doctors and pharmacists into probation officers and every pain patient into a criminal until they prove otherwise.

      Without any doubt the cure will be worse then the condition, that ALWAYS happens when people start saying “Something must be done” .

      Maybe this but it will never happen here,

      Why hardly anyone dies from a drug overdose in Portugal. Portugal decriminalized the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one.

      https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/

      This will never happen in psycho crack down zero tolerance America.

  5. People become addicted for a number of reasons. One is that, quite frankly, the abuse of these medications feels REALLY really good (I’m a recovery addict, I can vouch for this.) So bad information and bad practices put these medications out there but the side effect of euphoria keeps things moving. I use non-narcotic pain meds now and they don’t give you a buzz, and they aren’t habit forming. The “good stuff” that relieves pain the most effectively always gets you high if abused, or if you are just sensitive Don’t even tell me meditation and Advil work like Demerol. It’s a messy situation all around.

  6. This is egregious. If they would just take the hepatotoxic acetaminophen out of the opioids they wouldn’t be so lethal.

    The director of injury prevention is unqualified for the job and it looks like working at CDC is going to be the end of her: http://pasteboard.co/zVTpsI2z.jpg
    She said in an interview that doctors should “Max out” with “safe” SSRIs before resorting to opioids. Clearly she has done no serious investigation.

    “We absolutely want to treat your pain, but we want to do it safely.”

    We absolutely want you to stay out of our doctor’s prescription pads when you don’t know enough about drugs to say which ones are safe.

    The epidemic is antipsychotics, with more money spent on Abilify than on any other drug in some recent years, and 11% of the population taking an antidepressant. Not to mention stimulants, which 10% of high school boys are prescribed.

  7. Doctors should be much more discrete in the drugs that they use. We have a serious prescription drug problem in this country. Drug cocktails have been doing a great deal of damage for some time.

    Yes, we need to end the war on drugs. It has resulted in all sorts of deaths, filling prisons, needlessly, and the list goes on and on.

    We also need to stay the prescribing power of medical doctors. Pain killers, as has been shown over and over again by the media, can and do become killers if used to excess. When medicine is killing people, I daresay it isn’t medicine.

  8. Look up statistics of the amount of deaths due to causes such as overdose, cancer, circulatory problems, disease associated with smoking cigarettes. You will find that the amount of death causeb by opioids is far far lower than another above I mentioned. Opioids are not making money anymore for big Pharma, why do you think states who have approved medical use of cannablis. Come this fall there will be a voting by congress to legalize the recreational use of weed. There will be a 15% tax increase on the sell of weed and a surchage tax of 35%. If truly meant to help prevent deaths, the medical field would have been working much harder to wipe cigarrettes of the map of the earth, they do not because of tax. Now big pharmas want to put mind controlling drugs in with the pain pills. I fear my children are going to be walking Nazi’s and their children will be walking robots. This has to be stopped and if we do not get rid of the present government now & forever, America will never be a free great America. Countries are laughing at us where they use to look up to us. We say we have a president, but who really is in charge, Big Money Bigger Money and then the rich from other countries. Godbless us all!