Difference between revisions of "Expand & Enhance Chronic Pain Prevention & Management"

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Return to the &nbsp;[[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids]]) __TOC__
 
  
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*Chronic pain occurs when pain last for longer than 3 months.<ref>[1] Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
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*Pain affects more Americans than diabetes, heart disease and cancer combined.<ref>[2]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
 
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*25.3 million American adults suffer from daily pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
 
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*23.4 million American adults report a lot of pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.</ref>
 
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*14.4 million American adults suffer the highest level of pain, category 4.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
 
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*Today, chronic pain is the most common cause of long-term disability in the U.S.<ref>[6]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
 
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Chronic Pain and Opioid Use Among Seniors
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Brief Description
  
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Chronic pain is the primary reason seniors are prescribed opioids -- and use of opioids has many negatives for seniors (great article)<ref>[7] How the Opioid Crisis Affects the Elderly | Updated for 2019. (2018, September 4). Retrieved November 24, 2019, from AgingInPlace.org website: https://www.aginginplace.org/how-the-opioid-crisis-affects-the-elderly/
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= Introductory Paragraph =
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== Risk factors ==
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The Centers for Disease Control (CDC)&nbsp;and Prevention&nbsp;[https://www.cdc.gov/nchs/nvss/vsrr/%20drug-overdose-data.htm#drug_specificity estimates<ref>https://www.cdc.gov/nchs/nvss/vsrr/ drug-overdose-data.htm#drug_specificity</ref>&nbsp;]that 70,980 Americans died of a drug-related overdose in 2019, an increase of 4.6% compared to 2018. At the same time, nearly 100 million Americans experience chronic pain and are often prescribed opioid painkillers. There is little evidence to support the long-term use of prescription opioids for noncancer-related chronic pain. In addition, long-term opioid therapy has&nbsp;[http://s.%20https//www.cdc.gov/drugoverdose/%20prescribing/faq.html known risks],<ref>http://s. https//www.cdc.gov/drugoverdose/ prescribing/faq.html</ref> such as opioid use disorder and overdose, particularly with high doses. Further,&nbsp;[https://www.cdc.gov/drugoverdose/prescribing/faq.html evidence exists]&nbsp;<ref>https://www.cdc.gov/drugoverdose/prescribing/faq.html</ref>that non-opioid therapies can be effective with less harm. Given the clear risks that opioids pose, reducing unnecessary prescriptions and increasing access to effective non-opioid* forms of pain management are important strategies states can use to confront the opioid overdose epidemic.<ref>https://www.nga.org/center/publications/expanding-access-non-opioid-management-chronic-pain/</ref><br/> <br/> Chronic pain occurs when pain last for longer than 3 months.<ref>Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview</ref><br/> Pain affects more Americans than diabetes, heart disease and cancer combined.<ref>Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html</ref><br/> 25.3 million American adults suffer from daily pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref><br/> 23.4 million American adults report a lot of pain.<ref> Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.
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</ref><br/> 14.4 million American adults suffer the highest level of pain, category 4.<ref> Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017
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</ref><br/> Today, chronic pain is the most common cause of long-term disability in the U.S.<ref>Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html</ref><br/> Chronic Pain and Opioid Use Among Seniors
  
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for chronic pain include:
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= Key Information =
  
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&nbsp;
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The Pain Management inter-agency task force introduced best practices for patients managing acute and chroinc pain.<ref>https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf</ref>&nbsp; The task force emphasized patient-centered care in diagnosis and treatment of acute and chroic pain.&nbsp; The report also focuses on a multi-disciplinary&nbsp;and multi-faceted approach. A multidisciplinary approach for chronic pain includes&nbsp;various disciplines, and more than one treatment modoality when clinically indicated to improve overall outcomes.&nbsp;&nbsp;
  
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*genetics - heritability accounts for 38.4% of the variation in chronic pain risk<ref>[8] Genetic and environmental risk factors for chronic pain. (n.d.). Retrieved November 24, 2019, from ScienceDaily website: https://www.sciencedaily.com/releases/2016/08/160816151850.htm
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These include the following the following&nbsp;treatment categories:&nbsp;<br/> <br/> • Medications<br/> • Restorative Therapies<br/> • Behavioral Approaches for psychological, cognitive, emotional, behavioral, and social aspects of pain&nbsp;<br/> • Complementary and Integrative Health, including treatment modalities such as acupuncture, massage, movement therapies (e.g., yoga, tai chi), and spirituality.<br/> •&nbsp;Health systems and clinicians consideration of client population needs- child/youth, elderly, women, pregnant women, and special population needs such as sickle cell or needs of veterans, cancer patients and other chronic medical diagnosis.&nbsp;<br/> • Risk assessment &&nbsp;Risk stratification&nbsp;<br/> • Addressing & Reducing Stigma&nbsp;<br/> •Education<br/> • Research and Development
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</ref>  
 
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*female gender<sup class="reference"><ref>O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>  
 
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*older age<sup class="reference"><ref>[9]Hecke, O. van, Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111(1), 13–18. https://doi.org/10.1093/bja/aet123
 
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</ref></sup>
 
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*race and ethnicity<sup class="reference"><ref>[10Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref></sup>
 
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*being a military veteran<sup class="reference"><ref>[11]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref></sup>
 
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*low socioeconomic status<sup class="reference"><ref>[12]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
 
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*employment status and occupational factors<sup class="reference"><ref>[13]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
 
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*history of abuse or interpersonal violence<sup class="reference"><ref>[14]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
 
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*anxiety and depression<sup class="reference"><ref>[15]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
 
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*existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system<sup class="reference"><ref>[16]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
 
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</ref></sup>  
 
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*lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem<sup class="reference"><ref>[17]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
 
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</ref></sup>  
 
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*previous surgery<sup class="reference"><ref>[18]McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.
 
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</ref></sup>
 
  
 
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== Managing Chronic Pain ==
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''''''Risk factors''''''<b>&nbsp;for chronic pain include:</b>
  
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*8 Million Americans are on long-term opioid therapy for chronic pain<sup class="reference"><ref>[19]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>  
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*genetics - heritability accounts for 38.4% of the variation in chronic pain risks.<ref>Genetic and environmental risk factors for chronic pain. (n.d.). Retrieved November 24, 2019, from ScienceDaily website: https://www.sciencedaily.com/releases/2016/08/160816151850.htm</ref>  
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*1 million are taking dangerously high doses<sup class="reference"><ref>[20]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>
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*female gender<ref>Hecke, O. van, Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111(1), 13–18. https://doi.org/10.1093/bja/aet123</ref>
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*The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD<sup class="reference"><ref>[21]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
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*older age<ref>https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref>&nbsp;(Chronic pain is the primary reason seniors are prescribed opioids.)<ref>How the Opioid Crisis Affects the Elderly | Updated for 2019. (2018, September 4). Retrieved November 24, 2019, from AgingInPlace.org website: https://www.aginginplace.org/how-the-opioid-crisis-affects-the-elderly/</ref>  
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</ref></sup>  
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*race and ethnicity<ref>Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref>
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*Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street<ref>[22]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
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*being a military veteran<ref>]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
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</ref>  
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*low socioeconomic status<ref>O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>  
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*With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids<sup class="reference"><ref>[23]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>  
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*employment status and occupational factors<ref>O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>  
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*Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control<sup class="reference"><ref>[24]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>  
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*history of abuse or interpersonal violence
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*anxiety and depression<ref>Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview</ref>
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*existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system<ref>https://www.webmd.com/pain-management/guide/pain-management-treatment-overview</ref>  
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*lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem<ref>McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.</ref>  
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*previous surgery<ref>Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref><br/> &nbsp;
  
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= Current Status =
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'''Managing Chronic Pain'''<br/> 8 Million Americans are on long-term opioid therapy for chronic pain<ref>Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref><br/> 1 million are taking dangerously high doses<ref>Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html</ref><br/> <br/> The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD<ref>Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref><br/> <br/> Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street. With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids.&nbsp;
  
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Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis.<sup class="reference"><ref>[25]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref></sup> One of the cornerstones of the strategy is the prevention of chronic pain.<ref>[26]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref>
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Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control.<ref>National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref><br/> <br/> '''Current Status'''<br/> Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis.&nbsp;One of the cornerstones of the strategy is the prevention of chronic pain.<ref>Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html</ref>
  
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= Promising Programs =
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= Relevant Research =
  
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== Avoiding Illness and Injury ==
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'''The DiscovEHR Project'''<br/> <br/> A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.<ref>Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref>
  
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Workplace injury and illness prevention programs at both establishment and corporate levels are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities and lowering workers' compensation and other costs<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">.<sup class="reference"><ref>[27]Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
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In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development.<ref>Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html</ref>
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<span style="font-family: Tahoma; font-size: 12.8px;">Educational Programs</span>
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With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options.<ref>National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref>
  
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*<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Back Pain - Don't Take It Lying Down (Australia) - a 3 year campaign in Australia in the late 1990s that used mass media and other methods to promote several evidence-based concepts about back pain. <sup class="reference"><ref>[28]Buchbinder R. Can we change a population’s perspective on pain? In: Croft P, Blyth FM, van der Windt D, editors. Chronic pain epidemiology: From aetiology to public health. Oxford, England: Oxford University Press; 2010. pp. 329–344.</ref></sup> </span>  
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The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.<br/> <br/> '''Evidence Brief: Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain-'''<ref>https://www.hsrd.research.va.gov/publications/esp/chronicpain.cfm</ref>Evidence based research aand review of a ultimodal care delivery models to relieve chronic musculoskeletal pain and minimize unintended consequences, define key elements of and the resources required for these models, and identify patients who are most likely to benefit from these models.
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**<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Outcome: "Dramatic improvements in what the public and clinicians believed about back pain, accompanied by a decline in related workers’ compensation claims and health care utilization during the campaign; those beliefs have persisted over time."<sup class="reference"><ref>[29]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/
 
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== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Behavior Change Programs</span> ==
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= Impactful Federal, State, and Local Policies =
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #ff0000; font-family: Tahoma; font-size: 12.8px">[need examples]</span></span></span><br/> &nbsp;
 
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== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Pain Self Management Programs</span> ==
 
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #090909; font-family: Tahoma; font-size: 12.8px">[[MyStrength|myStrength]] is an example of a promising pain management program.</span></span></span><br/> &nbsp;
 
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== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Private Facebook Group</span> ==
 
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Clare Rhodes runs a private Facebook group for chronic pain patients.<sup class="reference"><ref>[30]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
 
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== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">The DiscovEHR Project</span></span></span> ==
 
  
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.<ref> [31]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
+
The Federal Controlled Substances Act: Schedules and Pharmacy Registration<ref>https://www.dea.gov/drug-information/csa</ref>
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</ref></span></span></span></span></span></span><br/> &nbsp;
 
  
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= Tools & Resources =
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= Available Tools and Resources =
  
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[[TR_-_Expand_&_Enhance_Chronic_Pain_Prevention_&_Management|TR - Expand & Enhance Chronic Pain Prevention]]
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'''Expanding Access to Non-Opioid Management of Chronic Pain- A Guide for Governors'''<ref>https://www.nga.org/wp-content/uploads/2020/08/NGA_PainManagement.pdf</ref><br/> '''Rurual Community Action Guide-''' Building Stronger Healthy Drug-Free communities<ref>https://www.usda.gov/sites/default/files/documents/rural-community-action-guide.pdf</ref>&nbsp;<br/> &nbsp;
  
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= Scorecard Building =
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= Promising Practices =
  
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Potential Objective Details (Under Construction)</span></span></span></span><br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Potential Measures and Data Sources&nbsp;(Under Construction)</span></span></span></span><br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Potential Actions and Partners&nbsp;(Under Construction)</span></span></span></span></span></span></span></span></span></span>
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'''Pain Management Best Practices-&nbsp;'''Inter-Agency Task force to addess acute and chronic pain during the Opioid crisis.<ref>https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf</ref><br/> '''Project ECHO (Extension for Community Healthcare Outcomes)''', developed by Sanjeev Arora, M.D. External Link Disclaimer, at the University of New Mexico Health Sciences Center, is a collaborative model of medical education and care management that helps clinicians provide expert-level care to patients wherever they live.<ref>https://www.ahrq.gov/patient-safety/resources/project-echo/index.html</ref><br/> '''Veteran's Affairs&nbsp;Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain<ref>https://www.hsrd.research.va.gov/publications/management_briefs/default.cfm?ManagementBriefsMenu=eBrief-no125</ref>​​​​​​​'''
  
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<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">[[RTI_-_Expand_&_Enhance_Prevention_of_Chronic_Pain_&_Management|RTI Expand & Enhance Chronic Pain Prevention]]</span></span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span></span></span></span><br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span></span></span></span></span></span></span></span></span></span>
 
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[[Category:SAFE-Prescriptions and Medical Response]]
 

Latest revision as of 18:51, 20 September 2021

Return to ...

Brief Description

Introductory Paragraph

The Centers for Disease Control (CDC) and Prevention estimates[1] that 70,980 Americans died of a drug-related overdose in 2019, an increase of 4.6% compared to 2018. At the same time, nearly 100 million Americans experience chronic pain and are often prescribed opioid painkillers. There is little evidence to support the long-term use of prescription opioids for noncancer-related chronic pain. In addition, long-term opioid therapy has known risks,[2] such as opioid use disorder and overdose, particularly with high doses. Further, evidence exists [3]that non-opioid therapies can be effective with less harm. Given the clear risks that opioids pose, reducing unnecessary prescriptions and increasing access to effective non-opioid* forms of pain management are important strategies states can use to confront the opioid overdose epidemic.[4]

Chronic pain occurs when pain last for longer than 3 months.[5]
Pain affects more Americans than diabetes, heart disease and cancer combined.[6]
25.3 million American adults suffer from daily pain.[7]
23.4 million American adults report a lot of pain.[8]
14.4 million American adults suffer the highest level of pain, category 4.[9]
Today, chronic pain is the most common cause of long-term disability in the U.S.[10]
Chronic Pain and Opioid Use Among Seniors

Key Information

The Pain Management inter-agency task force introduced best practices for patients managing acute and chroinc pain.[11]  The task force emphasized patient-centered care in diagnosis and treatment of acute and chroic pain.  The report also focuses on a multi-disciplinary and multi-faceted approach. A multidisciplinary approach for chronic pain includes various disciplines, and more than one treatment modoality when clinically indicated to improve overall outcomes.  

These include the following the following treatment categories: 

• Medications
• Restorative Therapies
• Behavioral Approaches for psychological, cognitive, emotional, behavioral, and social aspects of pain 
• Complementary and Integrative Health, including treatment modalities such as acupuncture, massage, movement therapies (e.g., yoga, tai chi), and spirituality.
• Health systems and clinicians consideration of client population needs- child/youth, elderly, women, pregnant women, and special population needs such as sickle cell or needs of veterans, cancer patients and other chronic medical diagnosis. 
• Risk assessment & Risk stratification 
• Addressing & Reducing Stigma 
•Education
• Research and Development

 

'Risk factors' for chronic pain include:

  • genetics - heritability accounts for 38.4% of the variation in chronic pain risks.[12]
  • female gender[13]
  • older age[14] (Chronic pain is the primary reason seniors are prescribed opioids.)[15]
  • race and ethnicity[16]
  • being a military veteran[17]
  • low socioeconomic status[18]
  • employment status and occupational factors[19]
  • history of abuse or interpersonal violence
  • anxiety and depression[20]
  • existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system[21]
  • lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem[22]
  • previous surgery[23]
     

Managing Chronic Pain
8 Million Americans are on long-term opioid therapy for chronic pain[24]
1 million are taking dangerously high doses[25]

The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD[26]

Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street. With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids. 

Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control.[27]

Current Status
Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis. One of the cornerstones of the strategy is the prevention of chronic pain.[28]

Relevant Research

The DiscovEHR Project

A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.[29]

In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development.[30]

With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options.[31]

The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.

Evidence Brief: Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain-[32]Evidence based research aand review of a ultimodal care delivery models to relieve chronic musculoskeletal pain and minimize unintended consequences, define key elements of and the resources required for these models, and identify patients who are most likely to benefit from these models.

 

Impactful Federal, State, and Local Policies

The Federal Controlled Substances Act: Schedules and Pharmacy Registration[33]

Available Tools and Resources

Expanding Access to Non-Opioid Management of Chronic Pain- A Guide for Governors[34]
Rurual Community Action Guide- Building Stronger Healthy Drug-Free communities[35] 
 

Promising Practices

Pain Management Best Practices- Inter-Agency Task force to addess acute and chronic pain during the Opioid crisis.[36]
Project ECHO (Extension for Community Healthcare Outcomes), developed by Sanjeev Arora, M.D. External Link Disclaimer, at the University of New Mexico Health Sciences Center, is a collaborative model of medical education and care management that helps clinicians provide expert-level care to patients wherever they live.[37]
Veteran's Affairs Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain[38]​​​​​​​

Sources

  1. ^ https://www.cdc.gov/nchs/nvss/vsrr/ drug-overdose-data.htm#drug_specificity
  2. ^ http://s. https//www.cdc.gov/drugoverdose/ prescribing/faq.html
  3. ^ https://www.cdc.gov/drugoverdose/prescribing/faq.html
  4. ^ https://www.nga.org/center/publications/expanding-access-non-opioid-management-chronic-pain/
  5. ^ Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
  6. ^ Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
  7. ^ Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017
  8. ^ Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.
  9. ^ Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017
  10. ^ Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
  11. ^ https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf
  12. ^ Genetic and environmental risk factors for chronic pain. (n.d.). Retrieved November 24, 2019, from ScienceDaily website: https://www.sciencedaily.com/releases/2016/08/160816151850.htm
  13. ^ Hecke, O. van, Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111(1), 13–18. https://doi.org/10.1093/bja/aet123
  14. ^ https://www.ncbi.nlm.nih.gov/books/NBK92516/
  15. ^ How the Opioid Crisis Affects the Elderly | Updated for 2019. (2018, September 4). Retrieved November 24, 2019, from AgingInPlace.org website: https://www.aginginplace.org/how-the-opioid-crisis-affects-the-elderly/
  16. ^ Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/
  17. ^ ]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
  18. ^ O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
  19. ^ O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
  20. ^ Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
  21. ^ https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
  22. ^ McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.
  23. ^ Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
  24. ^ Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
  25. ^ Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
  26. ^ Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
  27. ^ National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview
  28. ^ Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
  29. ^ Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/
  30. ^ Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
  31. ^ National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview
  32. ^ https://www.hsrd.research.va.gov/publications/esp/chronicpain.cfm
  33. ^ https://www.dea.gov/drug-information/csa
  34. ^ https://www.nga.org/wp-content/uploads/2020/08/NGA_PainManagement.pdf
  35. ^ https://www.usda.gov/sites/default/files/documents/rural-community-action-guide.pdf
  36. ^ https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf
  37. ^ https://www.ahrq.gov/patient-safety/resources/project-echo/index.html
  38. ^ https://www.hsrd.research.va.gov/publications/management_briefs/default.cfm?ManagementBriefsMenu=eBrief-no125
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