Chronic Pain: Chronic Opioid Use may not be helpful

This was sent to me by a colleague who deals with chronic pain patients and tries hard to find ways to avoid long term opioid therapy when possible. 

Highlights findings from NIH's panel:

There's Scant Evidence for Long-Term Opioid Therapy in Chronic Pain.

"We don't know enough about who benefits from opioids and who doesn't, about who gets pain relief and who gets into trouble with adverse effects from these drugs."

It's also not clear which pain types respond to opioid therapy. "There are many different kinds of pain and some pain perhaps responds better than others.There's a huge gap in knowing which is the right hammer for the right nail."

   Chronic pain affects an estimated 100 million Americans or a third of the US population. About 25 million have moderate to severe chronic pain that limits activities and diminishes quality of life. Pain is the main reason Americans receive disability insurance.

Experts estimate the societal costs of pain at $560 billion to $630 billion per year in the United States due to missed workdays and medical expenses.

To manage pain long term, some 5 to 8 million Americans depend on opioids. 

From 2000 to 2010, the number of hospitalizations for addiction to a prescription opioid increased more than 4-fold to more than 160,000 per year.

When it comes to managing patients with legitimate pain conditions, physicians have little training. They're sometimes quick to label patients as "drug-seeking" or "addicts," and some even "fire" patients for merely voicing concerns about their pain management, the report notes.

"A more holistic approach to the management of chronic pain that is inclusive of the patients' perspectives and desired outcomes should be the goal," they write.

Because pain affects physical, emotional, and cognitive function, as well as interpersonal relationships and social roles, managing pain requires a multidisciplinary approach similar to that recommended for other chronic complex illness, such as depression, dementia, eating disorders, or diabetes.