June 20, 2016
For the past 25 years, doctors have been told to treat the underappreciated epidemic of chronic pain in our country. The main hospital certification agency and others have promoted pain rating scales as the “5th vital sign”, added onto the traditional blood pressure, temperature, heart rate and respiratory rate. Physicians and hospitals responded and we saw a surge in prescriptions for controlled opioid narcotic pain pills.
What did we discover? Opioids for acute pain (trauma, surgery, etc…) are readily justified by multiple studies. Yet, the evidence of benefit for opioids in chronic pain is very limited at best, and the risks are clear.
Recent published studies repeatedly show the scant benefits and very strong harms of opioids in chronic pain. In the past few weeks, a study in JAMA showed “Long-Acting Opioids Tied to Increased Mortality Unrelated to Overdose”. http://goo.gl/IqL9ne Compared to patients treated with non-opioid chronic pain meds (like gabapentin or amitriptyline), those using opioids for chronic pain had a 72% increased risk for death from causes other than unintentional overdose. http://archinte.jamanetwork.com/article.aspx?articleid=2522397 We already know unintentional (and intentional) overdose deaths are increased for those receiving chronic opioids for pain.
In Idaho in 2012, appx 90 opioid prescriptions were written for every 100 adults.
Maybe it would be worth the higher death rate if opioids were amazing medications for chronic pain. They are not. A meta-study combining 20 controlled trials showed opioid analgesics provide modest short-term pain relief, BUT the effect is not likely to be clinically important within guideline recommended doses. And most importantly, evidence on long-term benefits for chronic low back pain is lacking. http://jama.jamanetwork.com/article.aspx?articleid=2528212
Bottom line, chronic opioids are poor medications for chronic pain (including low back pain) and they increase the death rates for not only overdose but ALL cause mortality, including cardiovascular death (heart attacks).
CDC guidelines – http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm