Difference between revisions of "Expand & Enhance Chronic Pain Prevention & Management"
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Return to the [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids]]) __TOC__ | Return to the [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids]]) __TOC__ | ||
= Background = | = Background = | ||
| − | *Chronic pain occurs when pain last for longer than 3 months.<ref>https://www.webmd.com/pain-management/guide/pain-management-treatment-overview | + | *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 |
| − | *Pain affects more Americans than diabetes, heart disease and cancer combined.<ref>https://report.nih.gov/nihfactsheets/ | + | </ref> |
| + | *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 | ||
| + | </ref> | ||
*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> | *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> | ||
*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> | *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> | ||
*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> | *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> | ||
| − | *Today, chronic pain is the most common cause of long-term disability in the U.S.<ref>https://report.nih.gov/nihfactsheets/ | + | *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 |
| + | </ref> | ||
Chronic Pain and Opioid Use Among Seniors | Chronic Pain and Opioid Use Among Seniors | ||
| − | Chronic pain is the primary reason seniors are | + | 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/ |
| + | </ref> | ||
== Risk factors == | == Risk factors == | ||
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| | ||
| − | *genetics - heritability accounts for 38.4% of the variation in chronic pain risk<ref>https://www.sciencedaily.com/releases/2016/08/160816151850.htm</ref> | + | *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 |
| + | </ref> | ||
*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> | *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> | ||
| − | *older age<sup class="reference">[9]</sup> | + | *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 |
| − | *race and ethnicity<sup class="reference">[ | + | </ref></sup> |
| − | *being a military veteran<sup class="reference">[11]</sup> | + | *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> |
| − | *low socioeconomic status<sup class="reference">[12]</sup> | + | *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> |
| − | *employment status and occupational factors<sup class="reference">[13]</sup> | + | *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> |
| − | *history of abuse or interpersonal violence<sup class="reference">[14]</sup> | + | *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> |
| − | *anxiety and depression<sup class="reference">[15]</sup> | + | *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> |
| − | *existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system<sup class="reference">[16]</sup> | + | *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> |
| − | *lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem<sup class="reference">[17]</sup> | + | *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 |
| − | *previous surgery<sup class="reference">[18]</sup> | + | </ref></sup> |
| + | *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 | ||
| + | </ref></sup> | ||
| + | *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. | ||
| + | </ref></sup> | ||
| | ||
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== Managing Chronic Pain == | == Managing Chronic Pain == | ||
| − | *8 Million Americans are on long-term opioid therapy for chronic pain<sup class="reference">[19]</sup> | + | *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> |
| − | *1 million are taking dangerously high doses<sup class="reference">[20]</sup> | + | *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> |
| − | *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">[21]</sup> | + | *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 |
| − | *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></sup> |
| − | *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">[23]</sup> | + | *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 |
| − | *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">[24]</sup> | + | </ref> |
| + | *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> | ||
| + | *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> | ||
= Current Status = | = 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.<sup class="reference">[25]</sup> One of the cornerstones of the strategy is prevention of chronic pain.< | + | 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> |
| − | |||
| − | |||
= Promising Programs = | = Promising Programs = | ||
| Line 55: | Line 64: | ||
== Avoiding Illness and Injury == | == Avoiding Illness and Injury == | ||
| − | 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">[27]</sup></span><br/> | + | 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 |
| + | </ref></sup></span><br/> | ||
<span style="font-family: Tahoma; font-size: 12.8px;">Educational Programs</span> | <span style="font-family: Tahoma; font-size: 12.8px;">Educational Programs</span> | ||
| − | *<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">[28]</sup> </span> | + | *<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> |
| − | **<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">[29]</sup></span> | + | **<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/ |
| + | </ref></sup></span> | ||
| | ||
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== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Private Facebook Group</span> == | == <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Private Facebook Group</span> == | ||
| − | <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">[30]</sup></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">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 |
| + | </ref></sup></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">The DiscovEHR Project</span></span></span> == | == <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> == | ||
| − | <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. < | + | <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 |
| + | </ref></span></span></span></span></span></span><br/> | ||
= Tools & Resources = | = Tools & Resources = | ||
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[[Category:SAFE-Prescriptions and Medical Response]] | [[Category:SAFE-Prescriptions and Medical Response]] | ||
Revision as of 22:53, 24 November 2019
Return to the Zoom Map (Reduce Prescription of Opioids)
Contents
Background
- Chronic pain occurs when pain last for longer than 3 months.[1]
- Pain affects more Americans than diabetes, heart disease and cancer combined.[2]
- 25.3 million American adults suffer from daily pain.[3]
- 23.4 million American adults report a lot of pain.[4]
- 14.4 million American adults suffer the highest level of pain, category 4.[5]
- Today, chronic pain is the most common cause of long-term disability in the U.S.[6]
Chronic Pain and Opioid Use Among Seniors
Chronic pain is the primary reason seniors are prescribed opioids -- and use of opioids has many negatives for seniors (great article)[7]
Risk factors
for chronic pain include:
- genetics - heritability accounts for 38.4% of the variation in chronic pain risk[8]
- female gender[9]
- older age[10]
- race and ethnicity[11]
- being a military veteran[12]
- low socioeconomic status[13]
- employment status and occupational factors[14]
- history of abuse or interpersonal violence[15]
- anxiety and depression[16]
- existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system[17]
- lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem[18]
- previous surgery[19]
Managing Chronic Pain
- 8 Million Americans are on long-term opioid therapy for chronic pain[20]
- 1 million are taking dangerously high doses[21]
- 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[22]
- 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[23]
- With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids[24]
- 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[25]
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.[26] One of the cornerstones of the strategy is the prevention of chronic pain.[27]
Promising Programs
Avoiding Illness and Injury
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.[28]
Educational Programs
- 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. [29]
- 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."[30]
Behavior Change Programs
[need examples]
Pain Self Management Programs
myStrength is an example of a promising pain management program.
Private Facebook Group
Clare Rhodes runs a private Facebook group for chronic pain patients.[31]
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.
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.
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.
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.[32]
Tools & Resources
TR - Expand & Enhance Chronic Pain Prevention
Scorecard Building
Potential Objective Details (Under Construction)
Potential Measures and Data Sources (Under Construction)
Potential Actions and Partners (Under Construction)
Resources to Investigate
RTI Expand & Enhance Chronic Pain Prevention
PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]
| Reviewer | Date | Comments |
Sources
- ^ [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
- ^ [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
- ^ 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
- ^ 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.
- ^ 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
- ^ [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] 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/
- ^ [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
- ^ 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
- ^ [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
- ^ [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/
- ^ [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/
- ^ [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
- ^ [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
- ^ [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
- ^ [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
- ^ [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
- ^ [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
- ^ [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.
- ^ [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
- ^ [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
- ^ [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
- ^ [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
- ^ [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]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
- ^ [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
- ^ [27]Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
- ^ [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.
- ^ [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]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
- ^ [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
