In a report appearing online this week in the Annals of Internal Medicine the National Institutes of Health concludes that significant deficiencies exist both in the available evidence for long-term opioid therapy for chronic pain, and in the competence of clinical decision making surrounding this treatment approach. With respect to physician preparedness, the report states “…clinical decision making for long-term opioid therapy is complex and requires individualized benefit–risk assessments; opioid selection and dose initiation and titration strategies; integration of risk assessment and mitigation strategies; and consideration of alternative, nonopioid therapies.” The NIH contends that healthcare providers are poorly prepared to manage chronic pain, and many hold stigmas against their patients.
Following a review of available research, the NIH report notes that “…the lack of scientific evidence on effectiveness and harms of long-term opioid therapy for chronic pain is clear and is in striking contrast to its widespread use for this condition and the large increase in prescription opioid–related overdoses.” The report concludes that “Research is needed to understand long-term patient outcomes, the risks for opioid abuse and related problems, and the effects of different opioid prescription methods and risk mitigation strategies.” A news story about the report and recommendations may be read here. The journal abstract may be read here.
Posted on January 13, 2015