CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Unless doctors are treating people with cancer, who are dying or who have some other incurable but agonizing condition, they need to set an end point for the treatment, the guidelines say.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm
I am not going to copy/paste this diatribe on acute/chronic pain management. You can judge for yourself how much the input from the chronic pain community influenced the final published guidelines.
On ABC NEWS TONIGHT with David Muir … he and Dr Besser had about a 30 second discussion on the CDC’s opiate prescribing guidelines and I did not hear one word on those with chronic pain.. just about all those who die from Heroin OD’s
The common denominator for the reason that most people go to a practitioner’s office or ER is because of PAIN.
New CDC Painkiller Guidelines: Go Slow, Use Less
New guidelines from the Centers for Disease Control and Prevention urge doctors to take it easy in prescribing the potentially killer drugs, making it clear that overprescribing is driving an epidemic of opioid addiction.
The guidelines encourage doctors to try something besides an opioid when first treating pain, even suggesting ice and talk therapy. And if an opioid drug such as oxycontin is the best choice, they need to start with the lowest possible dose.
The guidelines, published in the Journal of the American Medical Association, also suggest that patients question whether they need such strong drugs to control their chronic pain.
The short take on the CDC guidelines:
- Don’t use opioids first. Try other methods such as Tylenol, ibuprofen or ice
- Talk to the patient about what they can expect. 100 percent pain-free may not be realistic or desirable
- Make sure the patient knows the risks
- Never start with the long-acting opiates and use the lowest possible dose
Opioid drugs, which are related to morphine and heroin, are dangerous, said CDC director Dr. Thomas Frieden.
“For the vast majority of patients, the risks will outweigh the benefits for chronic pain,” Frieden told reporters in a conference call.
It’s just advice, Frieden noted.
“We are not a regulatory agency so these are guidelines,” he said. “CDC does not regulate the practice of medicine.”
CDC says deaths from opioid overdoses have hit an all-time record in the U.S.
The drugs killed more than 47,000 people in 2014 -more than the 32,000 who died in road accidents. “It’s one of the few trends in this country where health is getting worse,” Frieden said.
The administration of President Barack Obama has made the overdose epidemic a political priority,
and Congress recently held up the appointment of the new Food and Drug Administration commissioner, Dr. Robert Califf, until he promised reforms.
“In 2013 alone, an estimated 1.9 million persons abused or were dependent on prescription opioid pain medication,” the CDC’s Dr. Deborah Dowell and colleagues wrote in the published version of the recommendations.
Frieden said he was “stunned” to learn that one out of every 32 patients given the highest doses of opiate drugs would die within two and a half years.
And it’s clear who’s to blame. “The prescription overdose epidemic is doctor-driven,” Frieden said.
But he said patients are responsible too, and they need to stop demanding the strongest painkillers and need to start talking to doctors about their expectations.
“The best treatment isn’t always the one that provides the most immediate relief,” Frieden said.
Unless doctors are treating people with cancer, who are dying or who have some other incurable but agonizing condition, they need to set an end point for the treatment, the guidelines say.
“Three days or less will often be sufficient. More than seven days will rarely be needed for most acute pain syndromes,” Frieden said.
Dr. Thomas Lee of Harvard Medical School agreed.
“Compassion for patients does not mean the elimination of all pain,” Lee wrote in a commentary in JAMA on the guidelines.
“There is, quite simply, no ‘getting it right’ when it comes to pain. It is both undertreated and overtreated.”
And there is plenty of pain in the U.S., Dowell and colleagues said.
“The number of people experiencing chronic pain is substantial, with US prevalence estimated at 11.2 percent of the adult population,” they wrote. They said 3 percent to 4 percent of the population prescribed long-term opioid therapy.
But other things work, too, to help chronic pain, they pointed out.
‘For example, cognitive behavioral therapy (CBT) had small positive effects on disability and catastrophic thinking,” the CDC team wrote.
“Exercise therapy reduced pain and improved function in chronic low back pain; improved function and reduced pain in osteoarthritis of the knee and hip,” they added.
Acetaminophen, sold often as Tylenol, works best first for arthritis.
“The new prescribing guidelines approved by the CDC are an important step in addressing America’s opioid crisis,” said Gary Mendell, founder and CEO of Shatterproof, a national non-profit organization focused on ending addiction.
Filed under: General Problems
We are Chronic Pain Paitents. Yes, we take opioids. We are responsible with our medications. Are addicted? No. Are we dependent? Yes. Dependent such as a diabetic on insulin. A statin to reduce cholesterol. Medications for AFib. Medications for mental health, etc…. All these medications are necessary for a quality of life and these patients are treated with dignity, humanity and respect.
We have to band together and fight for that. We are as deserving a patient group as any for that quality of life.
Living in constant, untreated pain is detrimental to our physical and mental health. How we choose to treat our pain is our choice. If we choose opioid, that’s fine. Being refused/denied opioid pain management stands against the Hippocratic Oath and is torture.
“The guidelines encourage doctors to try something besides an opioid when first treating pain, even suggesting ice and talk therapy.”
“Talk Therapy”?? Really?!?! I could literally throat punch the so called experts that thought that gem up. I hurt all the time but when I have a nasty flare up I don’t want to talk. I want to be left alone and die. Talk Therapy…Please
My therapy for them is to take a long walk of a short pier…
Seems the cdc is trying hard to grant all of Gary Mendell’s of shatterproof wishes. Mr Mendell is essentially practicing medicine without a lisence. He is a billionaire business man not a doctor. Is this why the cdc is bowing down to him?
The CDC seems to conveniently ignore the fact that Doctors wrote those prescriptions that got so many pain sufferers dependent on them. Those sufferers who trusted their Doctor’s judgment as to which pain medicine was appropriate for them – long before news of their addictive potential came to light in the public’s eye.
Now, not only are the patients worried sick they might be addicted AND their pain relief medicine will be taken away. The CDC only seems to care decades after prescription pads for millions of opioids were written (by the suffering patient’s DOCTORS) with no plan- not even a thought to the suffering of the patients that have been receiving them for years. Those hurt by these rulings are the patients alone, who will suffer the consequences of the CDC’s ruling, through no fault of their own, but trusting their Doctors medical judgement.
And the CDC wants you to blame those victims, not the Doctors who caused it, and now they’ve added insult to injury to those already suffering the most. They want you to believe the prescriptions wrote themselves, or the patients were just ‘junkies’.
Don’t buy this bull. Place the blame where it belongs. The Doctors knew exactly how addicting these medicines were all along, but their choice was to prescribe them anyway. With no game plan for treating the known (to them) high risk of addiction the opioids had for any patients they gave them to. They don’t even know how to medically treat their victims. I don’t think they even care about what they’ve done. They got paid.
They don’t care about our pain. They just want to dictate like their God!
They have no clue how chronic pain disables a persons life. I hope who make this rule, ( breaks their back and has no access to pain medication) then we’ll see how fast it changes their minds..
https://iom.nationalacademies.org/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf
Over 100,000,000 patients in pain
Just got screwed.
I just want to thank Mr. Frieden and the ” Expert Panel ” at the CDC sincerely thank you all , from the worldwide Heroin Dealers Cartel .
The people at the CDC are implying that a pain patient should only be given 3 days of pain medication. This might be ok for acute pain patients, but it is completely ridiculous for chronic pain patients. There is a large segment of the population that have chronic pain and the only drugs with efficacy in treating this pain are opioids or opioid derivatives. In the future, we may have better drugs to treat pain. But, today, the only drugs that alleviate severe chronic pain are the opioid and their derivatives.
The chronic pain patient is being ignored in all this rhetoric about the over use and abuse of opioids.
3 days is also ridiculous for acute pain
Risk?–They have it all wrong!
The CDC consistently talks about the risks of opioids. All medications have risks. The most serious risks associated with opioids include worsening or initiating sleep apnea, risk of overdose and development of Opioid Use Disorder (OUD/addiction). These risks are modifiable though.
Other treatments with serious risks, many that are essentially non-modifiable (meaning there is little if anything that can be done to reduce risk are prescribed routinely. Opioids are entirely different though. Most of the risks are modifiable and very small IF taken as prescribed. Sleep apnea can be treated with weight loss and CPAP (BiPAP for those with neurological disorders that can’t tolerate CPAP). If hormonal deficiencies develop, treat them. If sedation persists despite dosage adjustments, give a stimulant. Often they augment the effect of the opioid and lower pain level. Some patients are able to even decrease their dose. GI issues generally resolve with time except constipation if it occurs, treat it early. Dental issues can develop from lots of long term medications, advise them to use something like Biotene. They can discuss fluoride trays with their dentist and (gasp!) BRUSH WELL and often. If the patient is at high risk for aberrant behavior, automated medication dispensers prevent the patient from taking medication early. They should be engaged with support service like individual or group therapy, 12 Step groups, and have a support person involved in their treatment if possible. All patients using higher doses, those with sleep apnea, or where there is concern about compliance should have access to naloxon Ie with family and close friends educated regarding its use. Untreated chronic pain itself can lead to the development of an addictive disorder e the patient self medicates with alcohol or non-medically acquired opioids or benzodiazepines.
There is risk of gastrointestinal bleeding, liver, and kidney disease resulting from long term use of NSAIDS in addition to emerging concerns that they increase risk of a cardiac event. Acetaminophen can also damage the liver either from long term usage in moderate-high doses or with the ingestion of a very large amount in a short period of time.
Risks related to anti-coagulants are far worse with much less that can be done to prevent them. Some newer anti-coagulants do not have specific reversal agents placing patients at high risk of bleeding and possible death after an accident, medical emergency, if a drug interaction increases serum levels, or too much is ingested. Even those that can be reversed place patient at significant risk for hemorrhage.
The same applies to TNF inhibitors such as Enbrel and Humira which have become popular for treating rheumatoid arthritis and certain other autoimmune diseases. Doctors generally prescribe them far more readily, even when the patient has factors that make them more risky. Risks include death and disability resulting from development of infection secondary to immunosuppression and certain cancers. This makes zero common sense. Prescribing in unnecessary doses, longer than needed, or when the patient fails to demonstrate functional benefit isn’t smart. It really seems to be a moral issue about addiction and our countries Puritan roots that favor work, individual fortitude, and value suffering as pennance from sin.KM
Fine! Give me an end point for treatment, just make sure there’s an end point for the pain too! These people have no clue what it’s like to suffer 24/7, 365! It’s absolutely infuriating to think of what I’ve been through, and then hear this crap! They left some important information out of their guidelines… REALITY!
I don’t have one….but I will grow one….these so called experts at the CDC can suck my ****.
NO LUBE,,,,, JUST SCREWED? Bend over chronic pain community because hear it comes.