Caring For Your Patients – A Team-Based Approach For Pain Management

How will this module help you and your practice develop a safe approach to treating adults with pain?

This module will help by providing you with:

1. Six STEPS to improve the safety of acute and chronic pain treatment
2. Answers to common questions about treating patients with pain
3. Downloadable tools you can use in your office

Need to Know:

What is chronic pain?

Chronic pain is defined by the Centers for Disease Control and Prevention (CDC) as pain that lasts for greater than three months or beyond the time of normal tissue healing. Estimates of the overall prevalence of chronic pain vary, but recent data suggest that more than 10 percent of adults in the United States report having daily pain, with higher rates among the elderly.

What are the risks of long-term opioid use?

Opioids can have serious adverse effects, including overdose and death. Long-term use of opioids can result in tolerance, dependence, addiction, and OUD. Opioid use during pregnancy can result in poor pregnancy outcomes including fetal anomalies, premature labor, and neonatal opioid withdrawal syndrome. Opioids may reduce the probability of chronic pain resolution.

Is there evidence for the benefits of long-term opioid use?

Although more studies are needed, recent evidence suggests that for some patients, discontinuing long-term opioid therapy may actually improve pain, function, and quality of life.10 Multiple meta-analyses have demonstrated that chronic opioid therapy provides little benefit to patients.

What is opioid use disorder (OUD)?

OUD is a problematic pattern of opioid use leading to clinically significant impairment or distress. Specific criteria for OUD include two or more of the following over a 12-month period, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

1. Using larger amounts of opioids or over a longer period than was intended
2. Persistent desire to cut down or unsuccessful efforts to control the use
3. A great deal of time spent obtaining, using, or recovering from use
4. Craving, or a strong desire or urge to use a substance
5. Failure to fulfill major role obligations at work, school, or home due to recurrent opioid use
6. Continued use despite recurrent or persistent social or interpersonal problems caused or exacerbated by opioid use
7. Giving up or reducing social, occupational, or recreational activities due to opioid use
8. Recurrent opioid use in physically hazardous situations
9. Continued opioid use despite physical or psychological problems caused or exacerbated by its use
10. Tolerance (marked increase in amount, marked decrease in effect)
11. Withdrawal syndrome as manifested by the cessation of opioids or use of opioids (or a closely related substance) to relieve or avoid withdrawal symptoms

What about using opioids to treat acute pain?

Many acute pain conditions can be treated with non-opioid therapy. Limiting exposure to opioids for acute pain is considered an important strategy to minimize the development of OUD in those who are susceptible (see Step 4). If opioids are required, many conditions do not require more than a few days of opioid therapy. A recent systematic review showed that more than half of opioids prescribed for acute pain go untaken, and the unused pills are rarely stored safely.11 These unused pills can be potentially diverted to inappropriate use. Over half of those who misuse opioids get them from a family or friend for free.

A patient’s risk for long-term use of opioids has been correlated with the characteristics of initial prescriptions. For example, in one study, the CDC reported that the rate of long-term opioid use one year after therapy was 6.0 percent for persons with at least one day of opioid therapy but increased to 13.5 percent when the first episode of use was ≥8 days and 29.9 percent when the first episode of use was ≥ days.