A Response to the CDC Opioid Guidline: Implementing Integrative Therapies into Chronic Pain Care
Opioids are commonly prescribed for pain. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. But opioid pain medication use presents serious risks, including overdose and opioid use disorder. From 1999 to 2014, more than 165,000 people died from overdose related to opioid pain medication in the United States.
This increased risk for overdose and opioid use disorder drove the Center for Disease Control (CDC) to create a Guideline providing recommendations for safer prescribing practices for clinicians, including the conviction that patients should receive appropriate pain treatment based on a careful consideration of the benefits and risks of treatment options. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including non-opioid pain medications and non-pharmacologic treatments). Supporting the CDC, the Food and Drug Administration (FDA), has launched an action plan due to the concern of the growing opioid overuse, abuse, and overdose in the country.
“Patients with pain should receive treatment that provides the greatest benefit. Opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that non-opioid treatments, including non-opioid medications and non-pharmacological therapies can provide relief to those suffering from chronic pain, and are safer.” –Center for Disease Control and Prevention
The CDC guideline has also inspired conversation in the field of integrative medicine about providing alternatives to opioids for chronic pain care. Samueli Institute recently led a dialogue explaining the guideline and non-pharmacologic approaches to chronic pain care.
SI Webinar Looks Into New Approaches
In a webinar hosted to motivate discussion on the integrative, non-pharmacological approaches to chronic pain care, Samueli Institute (SI) and other experts shared the changes that need to occur in the area of pain care.
“What we really need to work towards is a cultural transformation that puts the patient at the center of a personalized, integrated, multi-disciplinary model that emphasizes self-care practices know to reduce pain.” –Bonnie Sakallaris, PhD, RN
The CDC is recommending practice transformation in three key areas:
1. When to initiate or continue opioids
2. How to select, determine dosage, choose duration, follow-up or discontinue
3. How to assess risk and addressing harm
In each of these areas, the CDC recommends working with patients to understand their goal and educate them on the risks and benefits of the treatment proposed. The recommendations emphasize the importance of non-pharmacologic therapy as a first line approach and in combination with pharmacological therapy.
In SI’s informational webinar, experts discussed not only the importance of the CDC’s opioid guideline but the implementation of the recommendations it provides.
“How would we change the processes in each of our clinics that would support implementation of these guidelines?” asked Diane Flynn, MPH, FAAFP
Additionally, Dr. Flynn suggested that clinics look at the whole person when treating pain. Considering that pain causes other medical issues and often stems from other medical issues, accessing the patient’s level of pain is only one step in treating them. Most importantly, it was decided that limiting the number of days in which a patient is medicated with opioids is best practice.
Dr. Diane Flynn noted that if symptoms of acute pain persisted following three or four days of opioid therapy, a deeper, underlying problem needed to be addressed. Non-pharmacologic therapies, including self-care therapies, allow pain patients to unmask core issues that lead to their pain symptoms; allowing them to heal.
Read Samueli institute’s pain management supplement on self-care; one of the references used to support the data in the CDC’s new guideline.
Samueli Institute’s Chronic Pain Breakthrough Collaborative is now seeking enrollment. Learn more.