Opioids for chronic noncancer pain

The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35–54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.

Opioid Guidelines for Chronic Noncancer Pain Issued by AAN

Opioid Guidelines for Chronic Noncancer Pain Issued by AAN

The risks of outweigh their benefits for treating chronic noncancer pain such as chronic headaches, low back pain, and fibromyalgia
— American Academy of Neurology 9/29/2014

(HealthDay News) — The risks of  outweigh their benefits for treating chronic noncancer pain such as chronic headacheslow back pain, and fibromyalgia, according to a new statement from the American Academy of Neurology (AAN).

According to the AAN, research indicates that while opioids may provide short-term pain relief, there is no proof that they maintain pain relief or improve patients' ability to function over long periods of time without a serious risk of overdose, dependence, or addiction.

Doctors should consult with a pain management specialist if a patient's daily opioid dosage reaches 80–120mg, especially if the patient isn't showing substantial improvement in pain levels and physical function, the statement advises. The statement, published in the September 30 issue of Neurology, also outlines ways for doctors to prescribe opioids more safely and effectively. These suggestions include: screening for depression and current and past drug abuse; creating an opioid treatment agreement with the patient; and using random urine drug screenings.

More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use,” Gary Franklin, MD, MPH, of the University of Washington in Seattle, said in an academy news release. “There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents,” he added. “Doctors, states, institutions, and patients need to work together to stop this epidemic.