Newswise — The use of opioids in management of cancer pain and palliative care is widely accepted. The use of opioids to treat chronic non-cancer pain is more controversial. Some of the consequences of long term opioid therapy are physical and psychological dependence, abuse, and addiction. The objective of the treatment of chronic pain is maintaining functionality and continued participation in society. The 2011 report from the Institute of Medicine revealed that 100 million Americans live with chronic pain. (1) To comply with the ethical prima facie obligation to treat pain and spurred on by the pharmaceutical industry advertisement, physicians have become excellent opioid prescribers. Americans represent 5% of the world population but consume 99% of the world’s hydrocodone supply. (2) Over 183,000 persons have died either directly or indirectly from prescribed opioids in the USA from 1999-2015. (3) Drug overdose driven by opioids is the leading cause of accidental death with 91 daily from opioids. (4)
Because of the type of patients and our interest in pain management, physiatrists rank in the top ve opioid-prescribing groups among all specialists, following only primary care and orthopedics. (5) Since chronic pain is disabling and since chronic disability is often associated with chronic pain, it is a signi cant part of a physiatrist’s practice. However, do physicians, training programs, and Continuing Medical Education (CME) courses prepare us to understand chronic pain and prescribe opioids following the CDC and American Society of Interventional Pain Physicians (ASIPP) Guidelines? Are we trained in the patient consent process for opioid therapy, in interpreting urinary drug screens, in monitoring program data, and in understanding addiction? Are these areas part of our SAE and Board Certi cation examinations? These are unmet challenges for our residency program directors, PM&R Residency Review Committee, and the American Board of PM&R.
Do our professional societies provide leadership in the national reform of the opioid epidemic? Should they develop guidelines for the use in opioids in the treatment of chronic pain? Should they be involved actively in advocacy as well as patient and society education? Physiatrists need to be involved in the research on community strategies to educate the public on the safety pro le of analgesics and new approaches for treating pain. CME should prioritize the safe prescribing of opioids and establish strategies regarding multimodal pain management, techniques, opioid abuse, and a balanced approach to ensure that patients su ering from chronic pain get relief. Also needed are written competencies in pain management and new areas of research to support alternatives to opioids. We hope the AAP will be a leader in addressing the opioid challenge.
1. Institute of Medicine: Relieving Pain
in America; A Blueprint for Transforming Prevention, Care, Education, and Research. Washington DC, The National Academies Press; 2011.
2. Report of the Interventional Narcotics Control Board for 2007: United Nations, New York 2008. Available at: http://www.incb.org/incb/rn/publications/ annual=report-2007.html
3. CDC. Wide-ranging online data for epidemiologic research (WONDERO Atlanta, GA. CDC, National Center for Health Statistics, 2016. Available at:
4. https://www.cdc.gov/drugoverdose/ epidemic/
5. Chen JH, Humphreys K, Shah NH, Lembke A. Distribution of Opioids by Di erent Types of Medicare Prescribers. JAMA 2016;76(2) 259-261