Prescription opioids have been increasingly prescribed as a miracle pill for chronic pain management. With the rise in opioid prescriptions has come a rise in an addiction often seen as a precursor to heroin. While there are a select number of patients who truly do benefit, it is very tricky to identify those patients in order to provide safe therapy.
The first step, says Christopher J. Burnett, MD, an assistant professor of anesthesiology at the Texas A&M College of Medicine and director of the Baylor Scott & White Health’s Temple Pain Clinic, is to follow the guidelines the United States Centers for Disease Control and Prevention (CDC) released last year. “The CDC guidelines, which outline when to prescribe these drugs and provide guidance for how to do so safely, are a good starting point for providers caring for chronic pain patients,” Burnett said.
The CDC guidelines do not apply to palliative care, hospice or to oncology patients being actively treated for their disease. “If they are providing end-of-life care, providers should do what is necessary to make the patient comfortable,” Burnett said. “The CDC guidelines are intended for the typical chronic pain patient.”
“Much of the time, the right thing to do for lower back pain is to simply wait,” Burnett said. “It might be an acute injury that will heal on its own given a little time.” There are a number treatment options available, such as anti-inflammatory medications, physical therapy, transcutaneous electrical nerve stimulation (TENS) units, acupuncture and massage.
“The population of patients who need opioids chronically is actually pretty small,” Burnett said. “For most people, the prescription comes with an exit plan. These medications are now considered to be a way to bridge to the next line of therapy,” he added.
Burnett suggests that a serious discussion about the risks of opioids with the patient be had before a prescription is made.
