Doctors with the American Academy of Neurology say the dangers of opioid use for chronic pain management far outweigh the benefits.
“The evidence of harm is high, and the effectiveness is low,” said Dr. Gary Franklin, author of the AAN’s new policy statement.
Among other things, Dr. Franklin suggests that doctors shouldn’t be quick to prescribe certain opioids, especially in large amounts, and he recommends primary care doctors refer patients to specialists.
As a physician who specializes in chronic pain, I believe the second part of statement is the most important. Dr. Franklin suggests that the risks of poorly managed pain medications outweigh the risks for certain chronic conditions, but he believes they can be helpful for other conditions when partnered with an experienced pain management physician.
“It seems likely that, in the long run, the use of opioids chronically for most routine conditions, such as chronic low back pain, chronic headaches, or fibromyalgia, will not prove to be worth the risk,” Franklin said. “However, even for more severe conditions, such as destructive rheumatoid arthritis, sickle-cell disease, severe collagen disease, or severe neuropathic pain, prescribers need specific guidance on dosing, publicly available brief tools to effectively screen patients for risk, and guidance on how to monitor patients for early signs of severe adverse events, misuse, or opioid use disorder.”
I’ve been likening our bodies to cars in previous posts, and the second part of the quote reminds me of another automobile example. Let’s say you’ve got a major issue with your car, say, engine failure or a fried electrical system. Would you take your car to the auto shop down the street, or would you take it to a shop that specializes in fixing your exact car type? If you want the best results, you’d take your car to the garage that specializes in your brand, because odds are they’ve had more experience with the exact problem you’re dealing with, and are more qualified to fix the issue.
Your body should be no different. Visits to our primary care physicians are like oil changes and tire rotations – regular visits keep everything running smoothly and can help catch minor issues before they become major problems. When you have a big issue, like you need ACL reconstruction or treatment for acute destructive rheumatoid arthritis, you’re better off seeing the specialist.
In essence, Dr. Franklin isn’t saying we should abolish opioid use for pain management – we just need to make sure people know the risks and follow their doctor’s advice. And if you truly believe your chronic condition is worth seeking medical advice, don’t be afraid to consult with a chronic pain specialist.
Related source: MedPage Today