Today using opioids to treat chronic pain seems quite obvious for a lot of clinicians. This trivialization, beyond the responsibility of both the clinician and the patient, is responsible for the dramatic increase of opioid misuses and overdoses.
An excellent article written by Dr. Daniel Alford in the last issue of NEJM proposed smart solutions. Prescriber education is one of them. It would allow a more specific approach to addressing the opioid-misuse epidemic: benefit-risk assessment of patient’s needs and care individualization. It should be completed with patient close follow-up and monitoring as well as the careful evaluation at each encounter of whether to start, continue, decrease, increase or stop the treatment.
Training should start early in the medical education and students have to be aware of the best practices for that type of prescription. All the options for chronic pain management have to be taught and not only to doctors but to all healthcare providers in order to tackle the lack of awareness and education in the field.
Beyond drugs, other alternatives should be tested and proposed, especially when an opioid-based treatment is stopped. Explanations have to be provided in order to reassure the patient that his/her pain is manageable without this type of drugs.
The whole discussion, and a whole lot of other healthcare themes, are closely linked to the doctor-patient relationship. Trust, collaboration and open discussion are all key in order to have the best outcomes for the patient.
As a conclusion, I would like to invite you to watch the fantastic talk given by Elliot Krane, an expert in chronic pain about how this disease invades the body, what are the treatment options and what’s next.
Overdose Death Rates – US National Institute on Drug Abuse
Understanding the Epidemic – US Centers for Disease Control and Prevention
How drug use changes the brain — and makes relapse all too common – STAT – April 2017
The Painkillers That Could End the Opioid Crisis – MIT Technology Review – August 2016
Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education – NEJM – February 2016
Mortality Trends Among Working-Age Whites: The Untold Story – The Commonwealth Fund – January 2016
Trends in Opioid Analgesic Abuse and Mortality in the United States – NEJM – January 2015
When Pain Kills – AARP – September 2015
Assessment & Management of Chronic Pain – Healthcare Guideline – ICSI – November 2013