A federal task force is calling for a far more individualized approach to pain management in the wake of the opioid epidemic.
The history of opioids in pain management is like a pendulum that has oscillated over a couple of centuries. Throughout the 19th century opioids were widely used to remedy both acute and chronic pain. As time passed, the dangerous properties of opioids became evident. From the 1920s until the 1990s, prescriptive use of opioids was severely restricted. Opioids were prescribed only to ease pain after traumatic injury, during recovery from surgery, and during end-of-life situations.
In the 1990s, the American Medical Association (AMA) categorized pain as a fifth vital sign
Pain was as significant an indicator of a patient’s current health as pulse rate, temperature, respiration rate, and blood pressure.
Physicians were strongly advised to ascertain their patients’ pain levels. When pain levels became elevated, treatment was expected to ensue. The treatment provided was usually the most convenient, i.e., a prescription for opioids. The inevitable result was a steep increase in the use of opioids by patients.
Opioids enjoyed a consequent resurgence of popularity
This surge in opioid use was also boosted by the non-stop promotional activities of pharmaceutical companies.
- As of 2012, physicians were annually writing as many opioid prescriptions as there were people in the United States.
- By 2016, abuse of opioid drugs had reached a level often described as an epidemic.
The AMA retracts its description of pain as a vital sign
The negative aspects of prolonged opioid use soon began to receive increased public attention. In 2016, the AMA retracted its description of pain as a vital sign. It also took other steps to discourage physicians from overprescribing opioids. Even so, more than 72,000 overdose deaths attributed to opioids (both prescriptive and illicit) occurred in 2017.
All these factors have caused the opioid pendulum to swing forcefully towards strict limitations on opioid prescription.
Federal task force publishes a draft report for public comment
The very real suffering endured by millions of chronic pain patients continues. In some cases, the new restrictions have resulted in depriving patients of any effective tool against their pain.
In response, physicians and their chronic pain patients are seeking effective alternative tools. This search is the focus of a December 31, 2018 draft report from the Pain Management Best Practices Inter-Agency, a federal task force. This task force was set up by the Comprehensive Addiction and Recovery Act of 2016.
Among the draft report’s factual findings are:
- Chronic pain impacts 50 million adults in the United States. Of these, about 20 million experience what the report calls “high-impact” pain. This is defined as pain that significantly interferes with daily life and work activities.
- Effective pain treatment needs to look at all aspects of a patient, including biology, social ties, and individual psychology. This means looking beyond pharmaceutical alternatives to opioids.
- Exercise, monitored physical therapy, treatment modalities such as acupuncture and biofeedback should all support the formulation of an effective treatment plan.
“It is imperative to strike a balance between ensuring that patients with painful conditions can work with their healthcare providers to develop an integrative pain treatment plan that optimizes function, quality of life, and productivity,” the task force emphasized in the report.
The task force also addressed what it views as flaws in the guidelines promulgated in 2016 by the Centers for Disease Control (CDC). Misinterpretations and gaps in the CDC’s guidelines have led to what the report calls “unintended consequences”. The report emphasizes the need to protect the provider-patient relationship by continuing to provide access to effective medication regimens.
The draft report is now in its public comment phase until April 1, 2019. For 90 days, the Department of Health and Human Services will accept and review responses from interested members of the public.
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Read the full article at: www.fiercehealthcare.com
Dr. Vahedifar's pain management strategies integrate cutting-edge medical technology with targeted interventions to minimize pain and treat pain’s underlying causes.
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