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NIH report: ‘A silent epidemic' of chronic pain

Data from a new US government report has shown the number of prescriptions written for opioids as well opioid overdose deaths have skyrocketed in recent years, highlighting a growing addiction problem in the US. In response, Time magazine reports, the National Institutes of Health (NIH) has released a report citing major gaps in the way American clinicians are treating pain.

In September, 2014, the NIH held a workshop to review chronic pain treatment with a panel of seven experts and more than 20 speakers. The NIH also reviewed relevant research on how pain should be treated in the US. The NIH findings detailed a lack of research into better treatment methods and poor preparedness among physicians. "The prevalence of chronic pain and the increasing use of opioids have created a 'silent epidemic' of distress, disability, and danger to a large percentage of Americans," the report authors write. "The overriding question is: Are we, as a nation, approaching management of chronic pain in the best possible manner that maximises effectiveness and minimises harm?"

The answer is no, the report reveals. The number of opioid prescriptions for pain has gone from 76m in 1991 to 219m in 2011, and according to recent US Centres for Disease Control and Prevention (CDC) data, the latest figures show around 17,000 opioid-related overdose deaths in 2011. Between 2007 and 2010, the number of hospitalisations for opioid addiction increased four-fold. Past addiction epidemics disproportionally affected non-white, low-income, inner-city citizens, but the current outbreak of prescription painkiller abuse is affecting mainstream white America.

The NIH says that based on its assessment, healthcare providers in the US are poorly prepared for managing pain, and many hold stigmas against their own patients seeking relief.

For better care, the NIH says the medical community needs to start applying individualised treatment for chronic pain, and a multi-disciplinary approach should be used. Since pain is both physical and emotional and can affect all aspects of a person's life, there should be more than one speciality involved in patient management. The NIH says there's a lack of data that favors long-term use of opioids, and that other treatments like physical therapy and alternative and complementary medicine should be considered.

Clinicians do not have enough guidance when it comes to prescribing strategies, the NIH notes, arguing that the root of the problem is the overall lack of knowledge of how to effectively treat pain. The NIH says new study designs are needed to better research chronic pain treatment. The NIH says the challenge of when to use opioids and when to avoid them remains a question that available data can’t answer, and it’s a knowledge gap that needs to be filled as soon as possible. "For the more than 100m Americans living with chronic pain, meeting this challenge cannot wait," the report concludes.

[link url=""]Full Time magazine report[/link]
[link url=""]Annals of Internal Medicine abstract[/link]

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