recent CDC decides to revise opioid prescribing guidelines Ease the suffering of millions of chronic pain patients and practitioners in the U.S.
Since a 2016 revision encouraged physicians to avoid opioids whenever possible, people with chronic pain have struggled to get the proper and necessary medications and doses. While these regulations were created to stem the devastating opioid misuse and overdose crisis, this sudden and dramatic change has negatively impacted chronic pain patients who are managing their pain by prescribing opioids with little else. valid choice.
The opioid crisis, along with 2016 opioid prescribing guidelines and a new state law restricting opioid prescribing practices, has forced many U.S. doctors and pain clinics to become more reticent about prescribing opioids for acute and chronic pain.
Opioids are most effective in relieving acute pain. But they are also prescribed to people with chronic pain as a last resort because these drugs can rapidly build opioid tolerance, require higher doses and increase the risk of abuse.
Opioid prescriptions nearly halved between 2012 and 2020 due to changes in guidelines. Reductions in overuse and abuse of prescription opioids are positive for society. But millions of chronic pain patients who benefit from appropriate opioid use suffer because of the lack of effective alternative treatments.
Chronic pain sufferers often report physical and mental exhaustion. They live with anxiety, depression, and fear, waiting for the next pain attack (which could come at any time) or for the pain to worsen. Chronic pain sufferers also spoke of “side effects with side effects” because their medication for pain can cause brain fog or leave them feeling exhausted. This, in turn, leads to inactivity and weight gain, which can lead to comorbidities such as diabetes and cardiovascular disease.
The recent revision of the CDC’s opioid prescribing guidelines is a step in the right direction for properly treating patients with chronic pain. But there is still a long way to go before we can provide the other safe and effective therapies they need and deserve.
In the incredible two decades of advances in medicine, the paradigm for the treatment of chronic pain has not changed. Basic treatment includes NSAIDs, antidepressants, and anticonvulsants, which often have challenging side effects such as dizziness, somnolence, nausea, and other gastrointestinal disturbances. Many chronic pain physician opinion leaders say that in clinical practice, only about one-third of patients can reduce pain by 50% with currently available medications. This may prompt clinicians and patients to turn to opioids as the only available alternative.
The lack of products in the current pipeline is largely due to our poor understanding of the complex pathophysiology and signaling pathways involved in chronic pain; the lack of preclinical pain models that can be translated into human efficacy; Compounds in development have had multiple clinical failures.
Although pioneering science by researchers such as Nobel laureate David Julius has led to promising pain targets, precision medicine approaches to treating pain have so far not proven successful. The lack of new scientific insights and these development failures has led healthcare investors to divert funds from chronic pain investments into other disease categories.
But chronic pain affects about 20 percent of the adult population. Therefore, the United States needs more attention, investment, and incentives from investors, biopharmaceutical companies and researchers, and the U.S. government to address this problem.
I applaud the CDC for revising their opioid prescribing guidelines, recognizing the needs of patients with chronic pain and respecting their autonomy to make decisions with their respective primary care teams. But I also recognize that this is not enough for the millions of chronic pain sufferers in our country and around the world who are struggling to manage their symptoms with existing therapies, including opioids.
Therefore, I fully support the NIH initiative to help long-term detoxification (heal), which focuses on enhancing preclinical, translational, and clinical research in pain management and the prevention and treatment of opioid addiction. But we need additional measures to help foster more R&D in this area.
The NIH and the U.S. government should support research and development in chronic pain through clinical grants, funding, and tax incentives. Regulations also need to reflect the urgency of the issue, with the FDA developing an accelerated approval program for chronic pain drugs and implementing a “credentials program” similar to its pediatric program to enhance investment in innovative chronic pain treatments.
We cannot continue to ignore the impact of this silent pandemic on our country while underinvesting in efforts to provide solutions. We need the strength of the U.S. government, combined with the investment community, biopharmaceutical companies, and research community, to step up efforts to provide chronic pain sufferers the treatment they deserve.
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