Opioids too risky for long-term use in chronic-pain patients

New guidelines offer strategies for clinicians on how to effectively and safely manage opioid prescription use in chronic noncancer pain patients.

Opioids too risky for long-term use in chronic pain patients
Opioids too risky for long-term use in chronic pain patients

HealthDay News -- The risks of opioids outweigh their benefits in treating patients with chronic headaches, low back pain, and fibromyalgia that is not associated with cancer, according to a new statement from the American Academy of Neurology (AAN) published in Neurology.

More than 100,000 people have died from prescription opioid use since policies changed to allow much more liberal long-term use, noted Gary M. Franklin, MD, MPH, of the University of Washington in Seattle, in an accompanying press release from the AAN.

Although research indicates opioids may provide short-term pain relief for patients diagnosed with chronic noncancer pain, there is no evidence that they maintain pain relief or improve a patients' ability to function over long periods of time without a serious risk of overdose, dependence, or addition, wrote Franklin.

If a patient's opioid dosage reaches 80 to 120 mg, providers should consult with a pain management specialist, especially if the patient is not showing substantial improvement in pain levels and physical function, advised the AAN.

The statement also provides strategies for clinicians to more effectively and safely prescribe opioids, including:

  • Create an opioid treatment agreement
  • Screen for current or past drug abuse
  • Screen for depression
  • Use random urine drug screenings
  • Do not prescribe medications such as sedative-hypnotics or benzodiazepines with opioids
  • Assess pain and function for tolerance and effectiveness
  • Track daily morphine-equivalent dose using an online dosing calculator
  • Seek help if the morphine-equivalent dose reaches 80 to 120 mg and pain and function have not substantially improved
  • Use their state's Prescription Drug Monitoring Program to monitor all prescription drugs the patient may be taking

The guidelines also called for a change in state and federal laws to ensure safer and more effective prescribing practices.

References

  1. Franklin GD et al. Neurology. 2014; doi: 10.1212/WNL.0000000000000839
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