Patients who deal with chronic pain do still benefit from the use of opioids. The trick, for any prescriber, is to identify those patients who are appropriate for opioid management and to provide that therapy safely.
The first step, says Christopher J. Burnett, MD, an assistant professor of anesthesiology at the Texas A&M College of Medicine and director of the Baylor Scott & White Health’s Temple Pain Clinic, is to follow the guidelines the United States Centers for Disease Control and Prevention (CDC) released last year. “The CDC guidelines, which outline when to prescribe these drugs and provide guidance for how to do so safely, are a good starting point for providers caring for chronic pain patients,” Burnett said.
Despite the concerns of some patients, the CDC guidelines are not intended to apply to palliative care, hospice or to oncology patients being actively treated for their disease. “If they are providing end-of-life care, providers should do what is necessary to make the patient comfortable,” Burnett said. “The CDC guidelines are intended for the typical chronic pain patient.”
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Sometimes the best thing to do for these patients is nothing. “Much of the time, the right thing to do for lower back pain is to simply wait,” Burnett said. “It might be an acute injury that will heal on its own given a little time.” If not, there are a number of other treatment options available including anti-inflammatory medications, physical therapy, transcutaneous electrical nerve stimulation (TENS) units, acupuncture and massage. If the patient does not improve over the course of three months with these conservative approaches, there are also a number of procedures that interventional pain physicians can perform to improve pain, enhance functionality and improve quality of life — as well as avoid long-term opioid use.
“The population of patients who need opioids chronically is actually pretty small,” Burnett said. “For most people, the prescription comes with an exit plan. These medications are now considered to be a way to bridge to the next line of therapy,” which might be injections or a physical therapy regimen, or possibly further diagnostics like imaging or a surgical consult. “All of these are intended to reduce reliance on opioids,” he added.