National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain

Abstract

This National Institutes of Health (NIH) Pathways to Prevention Workshop was cosponsored by the NIH Office of Disease Prevention (ODP), the NIH Pain Consortium, the National Institute on Drug Abuse, and the National Institute of Neurological Disorders and Stroke. A multidisciplinary working group developed the workshop agenda, and an evidence-based practice center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the workshop discussion. During the 1.5-day workshop, invited experts discussed the body of evidence, and attendees had opportunities to provide comments during open discussion periods. After weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepared a draft report that identified research gaps and future research priorities. The report was posted on the ODP Web site for 2 weeks for public comment. This article is an abridged version of the panel's full report, which is available at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#final report.

Opioid risk assessment in palliative medicine

“…Ongoing risk assessment through the course of treatment is crucial to ensure adequate opioid safety and efectiveness of care. 22 …”

Structured Management of Chronic Nonmalignant Pain with Opioids in a Rural Primary Care Office

“…The executive summary of the National Institutes of Health (NIH) Pathways to Prevention Workshop on The Role of Opioids in the Treatment of Chronic Pain states that, "Patients, providers and advocates all agree that there is a subset of patients for whom opioids are an effective treatment for their chronic pain, and that limiting or denying access to opioids for these patients can be harmful." 2 However, this summary goes on to caution that there have been certain groups identified, such as those with psychiatric illness and previous substance abuse history, as being at higher risk to misuse opioids. Unfortunately, these same groups who were more likely to misuse opioid medications were also more likely to be prescribed opioid medications and less likely to be involved in a structured monitoring program.…”

“…5 Making the situation even more complicated is that 40% to 70% of people treated for chronic pain may not be receiving ideal treatment. 2 Although opioid medication use in NMCP is fraught with risk, there is some limited evidence to support their use. The executive summary of the National Institutes of Health (NIH) Pathways to Prevention Workshop on The Role of Opioids in the Treatment of Chronic Pain states that, "Patients, providers and advocates all agree that there is a subset of patients for whom opioids are an effective treatment for their chronic pain, and that limiting or denying access to opioids for these patients can be harmful."…”

“…Approximately 5 to 8 million Americans use opioid medications for the treatment of chronic pain. 2 However, the opioid class of medication is associated with significant increases in morbidity and mortality. Compared with nonopioid medications the hazard ratio for total mortality is 1.64 during the first 6 months and for the first 30 days is 4.16.…”

“…It costs $560 to $635 billion dollars annually, outdistancing the cost of heart disease, cancer, or diabetes 1 and is the predominant reason for disability in most Americans. 2 The treatment of NMCP has the potential to have rippling effects that permeate our society. Approximately 5 to 8 million Americans use opioid medications for the treatment of chronic pain.…”