Reducing opioid use has become a national priority, but where does that leave the millions of Americans who suffer from underdiagnosed or undertreated chronic pain?
Do alternative treatments strategies like cognitive behavioral, physical and pharmacologic therapies alleviate chronic pain? And how should these alternatives be implemented for different populations with different needs?
These questions will be explored at a congressional briefing in Washington, D.C. next week, which is organized by the Patient-Centered Outcomes Research Institute. Beth Darnall, PhD, a clinical professor of anesthesiology, perioperative and pain medicine at Stanford, is one of the speakers.
Congress is considering legislation -- The Opioid Crisis Response Act of 2018 -- that would affect the federal funding allocated to address the opioid crisis, including funding for non-opioid pain treatments. So it is critical that Congress understand evidence-based research on implementing safer chronic pain treatments in real-world clinical settings, Darnall told me.
Darnall was invited to speak about her EMPOWER study, a clinical trial in which participants partner with their clinicians to slowly reduce their opioid dose over a year. Patients are randomized to receive pain self-management classes, cognitive behavioral classes for chronic pain, or tapering only.
"The goal is not zero opioids. We're aiming to help patients reduce to lower, safer doses without increasing their pain," said Darnall. "We are testing whether the two types of classes help."
Darnall argues that the best pain care is comprehensive and personalized to each patient's needs. Although she recognizes that stanching the flow of prescription opioids is important and can save lives, she says opioids can be part of a comprehensive care plan that works for some patients.
Much of the overprescribing of opioids was born from a lack of opioid data, lack of clinician education about how best to treat pain and lack of accessible alternatives. Limiting opioids alone will not solve these three underlying problems. We need to better train physicians, psychologists, physical therapists, nurses and all health care clinicians on how to treat pain, so patients have access to evidence-based pain care.
Photo by K-State Research and Extension