Expand & Enhance Chronic Pain Prevention & Management

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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, such as opioid use disorder and overdose, particularly with high doses. Further, evidence exists 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.

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

Key Information

Chronic pain is the primary reason seniors are prescribed opioids.

Risk factors
for chronic pain include:

• genetics - heritability accounts for 38.4% of the variation in chronic pain risks.
• female gender
• older age
• race and ethnicity
• being a military veteran
• low socioeconomic status
• employment status and occupational factors
• history of abuse or interpersonal violence
• anxiety and depression
• existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system
• lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem
• previous surgery
   

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

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

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.

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.

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.

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.

Impactful Federal, State, and Local Policies

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

Available Tools and Resources

Expanding Acces to Non-Opioid Management of Chronic Pain- A Guide for Governors

Promising Practices

Please link to any best practice models or case studies that highlight creative/innovative or successful efforts in support of this strategy. Is there a community that does a really good job in this area that other communities should replicate? Please write a brief description and provide a link.