Chronic pain and prescription opioid misuse and abuse are at an all-time high. Chronic pain affects around 50 million people in the U.S. each year, with 48 million people aged 12 years and older having used prescription drugs for nonmedical purposes during their lifetimes. Because opioid abuse is an epidemic, the Center for Disease Control and Prevention (CDC) has now developed guidelines for treating chronic pain without opioid medications.
The CDC collaborated with several advisory groups when creating the new pain management guidelines. The Board of Scientific Counselors (BSC) and the National Center for Injury Prevention and Control (NCIPC) were consulted along with the Department of Health and Human Services. The CDC formed an Opioid Guideline Workgroup (OGW) to provide observations about the new guidelines.
Statistics Regarding Opioid Use and Misuse
Opioids are prescribed to around 20% of patients who go to the doctor’s office for noncancer pain symptoms or a pain-related diagnoses. In 2012 alone, healthcare providers wrote 259 million prescriptions for pain medicines. Opioid prescriptions have increased from 2007 to 2012 at a 7.3% rate.
Chronic pain is defined as pain that lasts more than three months or past the time of normal healing. Estimates of the prevalence of chronic pain vary with a 2002 National Health And Nutrition Examination Survey showing that 14.6% of adults have current widespread or localized pain lasting at least three months. In another study, the overall prevalence of pain related to musculoskeletal conditions was estimated at 43% among U.S. adults.
Evidence related to Long-Term Opioid Therapy
The CDC presented several findings and evidence related to long-term opioid therapy for the treatment of chronic pain. Regarding effectiveness, the committee found no studies related to opioid therapy that was longer than one year. They concluded insufficient evidence regarding long-term pain medicine effectiveness. One large clinical study showed that long-term opioid therapy was linked to risk for opioid abuse or dependence. In addition, 10 uncontrolled studies found opioid addiction, abuse, and other outcomes ranged from 3-26%.
While reviewing the research, indirect evidence was found for various endocrinologic harms, such as erectile dysfunction related to low testosterone, as well as cardiovascular events. One study showed that opioid use was associated with increased odds of road trauma among drivers.
Main Principles of the New Guidelines
The CDC guidelines focus on chronic pain except for pain related to cancer of end-of-life care. These guidelines are targeted at primary care physicians who are prescribe most prescriptions for pain in the U.S. The CDC recommends doctors only use opioid medications after other therapies have failed, and when they are necessary, these drugs should be prescribed at the lowest doses possible.
The CDC suggests that only 3-7 days of medication be prescribed for pain, which is considered short-term treatment. These guidelines were more than one year in the making, and the CDC encountered many patient groups that protested the guidelines. These groups argued that the agency relied on weak evidence, and they feared that patients would be denied appropriate pain relief.
Centers for Disease Control and Prevention (2016).CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. Retrieved from: cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm