By R Carter
While many CPP’s object to the 2016 CDC Guidelines on Chronic Pain Management, the FDA, AMA, CATO Institute, ASRA (American Society of Regional Anesthesia and Pain Medicine), Interstitial Cystitis Association, dozens of chronic pain organizations such as DPPR, Pain News Network, individual practitioners Dr. Jeffrey Fudin, Dr. Thomas Kline, Dr. Collin Nguyen and many others, as well as news organizations such as POLITICO, have questioned the rationality and risks associated with that publication.
In my post dated March 14, 2019, Ohio Drug Overdose Data Good News for Chronic Pain Patients, I posted new data from 2017 showing clearly that opiate prescribing for chronic pain is not the source behind the continued rise in opiate overdose deaths in Ohio. Other reports are now surfacing which show the same results at state and federal levels.
Prior to 2019 prescribing guidelines for doctors in Ohio had no set limits for the use of controlled substances in treating chronic pain. Furthermore, Ohio had no definitions making a distinction between acute and chronic pain nor guidelines on the standards of care for such. This placed prescribers in a bind leaving them vulnerable to liability concerns in the face of an ever increasing number of opiate overdose deaths.
As such, nearly all primary care providers (PCP), stopped prescribing, following the only standards of care which had been published at a federal level, the 2016 CDC Guidelines for Chronic Pain. That document also being misguided and inaccurate resulted in pain specialists following guidelines designed for acute pain and opiate naïve patients by setting arbitrary fixed limits and caps on the use of opiates in treating chronic pain.
In the CDC’s opening statements on that publication, they admit that the data for the long term treatment of chronic pain with opiates is inconclusive.
It’s rational to conclude then, that the CDC and by extension the Federal Government, is advocating an experimental treatment one which has no known outcomes for risks and benefits.
Main findings of this updated review are consistent with the findings of the 2014 AHRQ report (1). In summary, evidence on long-term opioid therapy for chronic pain outside of end-of-life care remains limited, with insufficient evidence to determine long-term benefits versus no opioid therapy, though evidence suggests risk of serious harms that appears to be dose-dependent.
Obviously some of the dose dependent risks not considered by the CDC were risks associated with forced tapering or forced termination of opiates and the resulting rise in suicides.
What I find most telling in all of this is how government uses data they collect to justify continued restrictions on opiates for chronic pain while the very data they use is inconclusive and used out of context. This fact has led those with any common sense to conclude that the guidelines and regulations coming from Federal and State agencies are a poor attempt to solve a problem directed at the wrong source.
And for all the backlash which has occurred because of it, our elected officials remain silent, except for a select few who raise their heads long enough to regurgitate the same irresponsible half-baked rhetoric which continues to irresponsibly harm tens of thousands while having tragic consequences for others.