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Managing Chronic pain

Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions, but also among the most controversial and complex to manage. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain and the limited therapeutic alternatives for chronic pain have combined to produce an over-reliance on opioid medications in the United States, with associated alarming increases in diversion, overdose and addiction. Given the lack of clinical consensus and research-supported guidance, physicians understandably have questions about whether, when and how to prescribe opioid analgesics for chronic pain without increasing public health risks.
 

Many medical specialty societies, including CAFP, have been working to provide the educational tools and resources physicians and their practice teams need to work with patients to appropriately diagnose, treat and manage chronic pain, with and without the use of opioid medications.  We are pleased to provide a wide array of these tools, resources and links to more information. Please contact CAFP with questions and concerns.


Opioids for the Treatment of Pain

Opioids are commonly prescribed because they are effective in relieving many types of pain. These medications are classified as narcotics and can be dangerous when abused. When used properly, opioids such as morphine have long been known to help the severe pain that follows surgery and to alleviate the suffering of people with advanced cancer. Recently, morphine and similar drugs have been used to treat chronic pain not caused by cancer. For many people, they have been remarkably helpful; for others, they either haven’t worked or have created problems over time.

PDMPs

Prescription drug monitoring programs (PDMPs) and “pill mill” laws have been used to target risky opioid prescribing practices. A new CDC Injury Center study published in Drug and Alcohol Dependence evaluates the effect of these policy changes on high-volume prescribing behaviors among providers in Florida. In the year following PDMP and policy implementation, decreases were seen among high-volume prescribers in the number of patients with an opioid prescription, monthly total opioid volume, average morphine equivalent dosage dispensed and number of opioid prescriptions.

AAFP Tools

The American Academy of Family Physicians (AAFP) has developed resources to help combat the opioid abuse epidemic, including a chronic pain management toolkit and a continuing medical education (CME) webcast on chronic opioid therapy.

Project ECHO

The California Health Care Foundation and the Center for Care Innovations have partnered with the Weitzman Institute to develop a new program to help health care providers throughout California treat opioid-addicted patients. Providers will participate in real-time case discussions with primary care practitioners actively treating substance abuse and addiction .

Tools and Resources

Continuing medical education and professional development to address the management of chronic pain, including, but not limited to, the use of opioids, is one very important means to improve patient care. The Interstate Postgraduate Medical Association (IPMA) has developed an MOC Part IV module, approved for American Board of Family Medicine Part IV MC-FP credit. The Food and Drug Administration released a Risk Evaluation and Mitigation Strategy (REMS)for extended-release/long-acting opioids in 2012. The REMS includes continuing education for clinicians/prescribers, patient safety education, resources for storage and disposal, and use of prescription drug monitoring programs.