Key evidence gaps and research priorities must be addressed “so that physicians can recognize patients for whom opioids are most appropriate and use optimal regimens for these patients,” according to the National Institutes of Health (NIH) Pathways to Prevention Workshop final report on the role of opioids in the treatment of chronic pain.
The workshop panel called for federal and nonfederal agencies to sponsor research “to identify which types of pain, specific diseases, and patients are most likely to benefit and incur harm from opioids,” as well as the development of multidisciplinary pain interventions. “In the absence of definitive evidence, clinicians and health-care systems should follow current guidelines by professional societies about which patients and which types of pain should be treated with opioids and about how best to monitor patients and mitigate risk for harm,” the panel recommended.
Among the clinical issues considered by the panel were the challenge of appropriate patient selection and how the type of pain could influence its management. “Data were presented on three distinct pain mechanisms: peripheral nociceptive (caused by tissue damage or inflammation), peripheral neuropathic (caused by damage or dysfunction of peripheral nerves), and centralized (characterized by a disturbance in the processing of pain by the brain and spinal cord). Persons with more peripheral nociceptive pain (such as acute pain due to injury, rheumatoid arthritis, or cancer pain) may respond better to opioid analgesics,” the panel stated.
The lead author of the report was David B. Reuben, MD, of the David Geffen School of Medicine at the University of California, Los Angeles. The abridged report is published in Annals of Internal Medicine, and the full report at is available at the NIH website https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#finalreport. ■
Reuben DB, et al: Ann Intern Med. January 13, 2015 (early release online).