Will new opiate advice leave some in pain?
The American Academy of Pain Medicine estimates that about 100 million Americans live with chronic pain. There are more people suffering from chronic pain than people with diabetes, heart disease and cancer combined. It affects quality of life, ability to work and can lead to other debilitating medical conditions such as anxiety and depression.
Increasingly, doctors now have to balance their compassion for patients suffering from real pain with the knowledge that opioids are being sought by those who have a substance abuse disorder.
“We’re getting better and more creative in alternate ways of treating the pain,” said Donald Guadagnoli, MD, Chief Medical Officer of Cape Cod Healthcare. “We’re using more IV Tylenol and our orthopedists are using more regional blocks. But there is still a place for the use of narcotics, and really it’s not something that can be dictated from afar. The reality is that most doctors are trying to take care of their patients in the best way that they can and they’re not callously prescribing enormous amounts.”
According to the Centers for Disease Control and Prevention an average of 78 Americans die from an opioid overdose every day.
On March 18, the CDC decided to take action, issuing new guidelines for doctors prescribing opioids. The guidelines focus on treating those with chronic pain, which is defined by the CDC as “pain lasting longer than three months or past the time of normal tissue healing.” They do not include active cancer care, palliative care or end of life care.
The 12 guidelines for doctors include three key recommendations:
- Promote the use of non-opioid medicine for chronic pain. Non-pharmacologic therapies including physical therapy, weight loss for knee osteoarthritis and psychological therapies such as CBT should be tried first, followed by non-opioid pharmacologic therapies including acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants.
- If opioids are prescribed, doctors should prescribe the lowest dose of immediate-release opioids possible to prevent misuse and overdose. In the case of acute pain rather than chronic pain, the CDC suggests that three days will often be sufficient and more than seven days will rarely be needed.
- Doctors should always exercise caution when prescribing opioids and closely monitor all patients and evaluate benefits and harms within one to four weeks and then again at least every three months to see if benefits outweigh risks.
Will adhering to the guidelines prove to be effective in stopping the dramatic rise in addiction or will it prevent some patients with chronic pain from getting the treatment they need?
“We tend to be swinging one way or the other and missing the middle by a huge stretch,” Dr. Guadagnoli said. “The reality is in the 90’s there was a huge push to teach physicians to pay attention to pain, to make pain the fifth vital sign and to make sure that we took care of pain issues. Now physicians are being cast as evil because they’re addressing pain issues.”
Dr. Guadagnoli said that doctors tend to trust their patients who say they are in pain when they have a condition that actually causes pain, but they are also well aware that they are sometimes being taken advantage of by drug seekers.