Innovations In Clinical Neuroscience

Hot Topics in Pain Management October 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [October 2017] 14 non-prescription opioids reached a new crest in 2014 with 165,000 fatalities, the highest rates of overdose among people aged 25 to 54 years. 4 It will come as no surprise that the sales of prescription opioids have also quadrupled from 1999 to 2012. 5 Whereas prior to the 2000s, it was widely believed that risk of addiction was low in chronic pain populations. Recent data have revealed that as many as one in four individuals treated with prescription opioids for long-term non-cancer pain in primary care settings might struggle with addiction. 6 In light of these concerns, the CDC released guidelines for the prescription of opioids for persistent non-cancer pain (Table 1). 7 Many of the proposed guidelines promote the development of a treatment plan with a stepped-up approach to opioid therapy, i.e., the exploration of alternatives and attempts at ensuring adherence and utilization of available prescription monitoring resources. However, some controversial approaches might lead to the unintentional consequence of reduced patient access to providers while still giving patients access to medications that allow them to maintain some quality of life and reasonable function. NATIONAL PAIN STRATEGY Recognizing the burden of chronic pain, the United States Congress provided a mandate to the NIH to evaluate and make recommendations "to increase the recognition of pain as a significant public health problem in the United States." 8 The NIH contracted with the IOM, which developed a report calling for the development of a comprehensive, population health-level strategy to lead a cultural transformation in pain prevention, care, education, and research. 3 The National Pain Strategy is the result of HHS requesting the Interagency Pain Research Coordinating Committee (IPRCC) to oversee the development of such a strategy. The National Pain Strategy provides a focus on six key areas: • Population research • Prevention and care • Addressing disparities in care • Service delivery and reimbursement • Professional education and training • Public education and communication Through this broad focus, the National Pain Strategy envisions a decrease in the incidence and prevalence of acute, chronic pain across the life span from pediatric through geriatric populations, including end-of-life care. Those suffering from pain would receive timely access to comprehensive care tailored to their biological, psychological, and social needs based upon evidence and efficacy delivered in a patient-centric manner. Chronic pain is a complex disease and a significant public health burden; therefore, considerable efforts need to focus on recognition of risk factors as well as mitigation, prevention, and self- management strategies. This bold vision will need champions at the national, regional, state, and local levels. Disparities in care, in areas such as population research, might require large coordinated research infrastructures. Public and professional education, on the other hand, could be accomplished through the efforts of small groups working together toward the aims of better care for patients with chronic pain through prevention, comprehensive assessment, and evidence-based interdisciplinary care. Outlined below are some efforts at the local and regional level in the state of Kansas. KANSAS PARTNERSHIP FOR PAIN MANAGEMENT The Kansas Partnership for Pain Management is a multidisciplinary group comprising individuals from family medicine, anesthesiology/pain medicine, psychology, emergency medicine,

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