Bioethics Blogs

Managing Chronic Pain: Opioids Are Often Not the Answer

Opioids and researchThe term “silent epidemic” sometimes gets overused in medicine. But, for prescription opioid drugs, the term fits disturbingly well. In 2012, more than 259 million prescriptions were written in the United States for Vicodin, OxyContin, and other opioid painkillers. That equals one bottle of pain pills for every U.S. adult. And here’s an even more distressing statistic: in 2011, overdoses of prescription painkillers, most unintentional, claimed the lives about 17,000 Americans—46 people a day [1].

The issue isn’t whether opioid painkillers have a role in managing chronic pain, such as that caused by cancer or severe injuries. They do. What’s been lacking is an unbiased review of the scientific literature to examine evidence on the safety of long-term prescription opioid use and the impact of such use on patients’ pain, function, and quality of life. The NIH Office of Disease Prevention (ODP) recently convened an independent panel to conduct such a review, and what it found is eye-opening. People with chronic pain have often been lumped into a single category and treated with generalized approaches, even though very little scientific evidence exists to support this practice.

Based on its review of the literature and scientific research presented at the workshop, the seven-member panel concluded that chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, evidence-based approach to manage. The workshop was convened by ODP, the NIH Pain Consortium, the National Institute on Drug Abuse (NIDA), and the National Institute of Neurological Disorders and Stroke (NINDS).

Such individualization won’t be easy to achieve.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.