In March of this year, the Centers for Disease Control and Prevention released new pain management guidelines for health care providers relating to opioid use called the Guidelines for Prescribing Opioids for Chronic Pain. Specifically, these guidelines laid out suggestions on how physicians should curtail writing prescriptions for opioids. In the case of chronic pain patients, doctors are told to use opioid therapy prudently and continuously reevaluate if it is the correct course of action. It has been months since these new guidelines have been released and there has been a lot of lively discussions surrounding them. But what impacts are these new pain management guidelines having on the medical community and their patients?
Overview of the new CDC pain management guidelines
The new guidelines by the CDC have 12 recommendations for health care providers to follow concerning opioids. These boil down to the following goals:
- Use non-opioid therapies – The CDC suggests that doctors first use alternative treatments such as cognitive behavioral therapy or exercise before prescribing any kind of opioid. It also suggests that opioids are not used routinely for chronic pain patients and that they should be combined with other treatment options.
- Start low and go slow – If opioid therapy is used, doctors should use the lowest effective dose possible and avoid using extended release opioids. They should also limit the quantity prescribed to the minimum needed.
- Follow-up – Patients being treated with opioids should be monitored regularly and the risks versus rewards should be evaluated often. Patients not receiving meaningful benefits should be tapered off or removed entirely from opioid use.
Check out our article “New Opioid Guidelines – What You Need To Know” for a more in-depth review of each of these recommendations.
Response to these new pain management guidelines
The new pain management guidelines have certainly made big waves in the medical community and have sparked heated debate about their efficacy. Many people have weighed in on this topic from patients, nurses, and doctors with a mix of positive and negative comments about these new suggestions.
CDC director Thomas R. Frieden, M.D announced the new CDC pain management guidelines in an article describing the history and reasoning for more controls of opioids. He closes this article by saying:
“Management of chronic pain is an art and a science. The science of opioids for chronic pain is clear: for the vast majority of patients, the known, serious, and too-often-fatal risks far outweigh the unproven and transient benefits.”
Possible ramifications to new regulations
Numerous sources responded to these new pain management guidelines by highlighting all of the possible ramifications that will come about. A major point that has been raised by various sources believes that an increase in suicide rates is likely to occur. As patients lose access to pain medications, their quality of life might decrease so much that suicide might seem like the only option left.
One article from Pain Medicine New written by Lynn R. Webster, M.D., states:
“Pain News Network reports that dozens of patients have contacted the editor since March, when the guideline was made public, to say that their doctors have “fired” them on flimsy excuses, or that their doctors suddenly are weaning them off opioids or abruptly cutting them off from the medications. Worse is that some patients are so despondent and in so much pain that they have given up and looked to suicide as a way out.”
Others argue that the CDC has set dose recommendations that might be construed as hard limits to some doctors. These caps, set to 50mg per day in morphine and 90mg a day in rare occasions, could negatively impact patient care and quality of life. Bob Twillman, PhD, states in his article from The American Academy of Pain Management:
“The Academy commented extensively on these arbitrary threshold numbers, out of concern that they may prevent some people with pain from receiving adequate doses of opioids when those doses may be beneficial. While the numbers themselves are not especially draconian, the Academy’s concern has been that many primary care clinicians may interpret these thresholds as ceiling doses.”
Opinions of support
Some doctors have mixed feelings for the new pain management guidelines, but are supportive of the overall goal. The American Medical Association released a brief statement that questioned the scientific evidence supporting some of the new CDC guidelines and voiced concerns that there could be further consequences concerning paying for alternative treatments:
“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care.
They go on to acknowledge that the opioid epidemic is a complex issues that will likely as time evolves stating:
“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word.”
Not all clinicians feel that the new CDC regulations are in error and have thrown their full support behind the CDC. In a JAMA article, The CDC Guideline on Opioid Prescribing, Yngvild Olsen, M.D., states that:
“The CDC guideline for prescribing opioids for chronic pain is an important and essential step forward. With support from physicians across the country, as well as from policy makers at all levels, implementation of the recommendations in this guideline has the potential to improve and save many, many lives.”
Dr. Olsen does also mention that significant gaps in the health care system will have to be addressed before a large scale reduction of opioids will be safe to implement. This includes reimbursements for both chronic pain and addictions treatments alike.
How do you feel about the new CDC guidelines? Do you think it will help reduce opioid abuse or will it have more consequences than it is worth? Find our opioid therapy statement online.
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