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May 2016

Seeking Balance Between Pain Relief and Safety: CDC Issues New Opioid-Prescribing Guidelines

Author Affiliations
  • 1Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2016;73(5):513-514. doi:10.1001/jamaneurol.2016.0535

Pain is a symptom common to numerous physical and psychiatric ailments and can often be managed by treating the underlying condition. However, in approximately 20 million patients each year, chronic pain persists despite treatment.1,2 Chronic pain is complex, heterogeneous, and poorly understood. Patients with chronic pain experience a decreased quality of life and increased risk for multiple comorbidities, costing society billions of dollars in reduced productivity annually. Therefore, equipping physicians with effective tools and guidelines for chronic pain management is of paramount importance.

Chronic pain can be managed with both pharmacologic and nonpharmacologic options, such as behavioral and physical therapy. Unfortunately, insurance coverage for multidisciplinary pain management is limited, which places much of the responsibility for treating chronic pain on primary care and prescription medications. Multiple pharmacologic options are available, including nonsteroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and opioids, but it is rarely possible to predict the safest and most effective medication for a given patient. Moreover, there is a paucity of clinical trials to guide physicians in treating chronic pain. In some cases, opioids are the only class of medications to which a patient responds, but because of dangerous adverse effects, including respiratory depression, unintentional overdose, and addiction, it is important for physicians, especially those in primary care, to be confident with prescribing them safely.