Pain, Opiates, and the New CDC Guidelines

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By Jerome Lerner, MD
Director, Pain Recovery Program at Sierra Tucson

On March 18, 2016, the Centers for Disease Control and Prevention (CDC) released new guidelines for the use of opiates in treating non-cancer pain. The report points out that opiate-related deaths have quadrupled since 1999. Twenty percent of patients seeking medical care for a pain-related condition walk out of the physician’s office with a prescription for narcotics. In the report, the CDC reviews the available research regarding effectiveness and risks of opiate medications to treat chronic non-cancer pain. The agency’s conclusion is that there is poor or no evidence to support long-term use of opiates. Therefore, opiates are not considered appropriate for the treatment of long-term pain.

Other recommendations found in the guidelines include:

  • Opiates should not be the first line of treatment in chronic pain.
  • Physicians should carefully reassess before prescribing more than 50 MME (morphine milligram equivalents) per day of narcotics.
  • Physicians should, for the most part, avoid equal to or greater than 90 MME per day.
  • Physicians should attempt to lower or eliminate opiate use in those using high-dose opiates (equal to or greater than 90 MME).
  • Physicians should be on the lookout for comorbidities such as anxiety, depression, and opiate-use disorders, which may be masked by prescribed opiate medication
  • Physicians should avoid the use of opiates in combination with benzodiazepines.

Through the Years
I have been practicing pain management in some form since the 1980s. In those days, opiates were used very modestly in the treatment of painful conditions. Instead, we relied on physical therapy, nonsteroidal anti-inflammatory drugs (NSAID), muscle relaxers, and biofeedback.

In the 1990s, things began to change. The American Pain Society (APS) proposed that pain was being under-assessed and under-treated, which perhaps was partly true at the time. In 1995, the APS proposed the use of pain assessment as the “5th vital sign,” which should be performed during all medical visits in order to ensure that pain was being managed humanely and effectively.

Additional Reasons for the Rise  
At some point along the way, it seems the pendulum shifted toward procedural pain management, which could also be a contributing factor to the growing use of opiate medications. While such procedures have their place in pain management, they often overlook the very real and relevant psychosocial, psychiatric, and substance use issues that lie beneath chronic pain. Delving into such issues can be difficult and time-consuming, yet prove to be a necessary component in the overall recovery process.

The Sierra Tucson Approach   
I am proud to be part of Sierra Tucson’s Pain Recovery Program. Here, we are able to support individuals struggling with longstanding pain by reducing or eliminating opiate medication use, while providing a myriad of safe and effective strategies to reduce pain and suffering and improve functioning and quality of life. Our comprehensive program includes safe medication management, vigorous functional restoration, in-depth pain education, and treatment of co-occurring conditions such as anxiety, depression, trauma, and substance use disorder. As expectations from the CDC increase and the use and availability of high-dose opiates diminish, I believe that Sierra Tucson is a perfect place for many people struggling with pain to find a truly integrative treatment approach and change the direction of their lives toward a healthier, happier reality.

For more information on Sierra Tucson’s Pain Recovery Program, call our Admissions Coordinators at 855-693-7208.

About Dr. Lerner
Jerome Lerner, MD, joined Sierra Tucson’s Medical Team in December 2010 as director of the Pain Recovery Program. He was appointed interim medical director in December 2012 and accepted the position of medical director in September 2013. Wisconsin born and raised,  Dr. Lerner received his medical education and specialty training at the Medical College of Wisconsin. He is board certified in physical medicine and rehabilitation, and is a diplomate  of the American Academy of Pain Management. Dr. Lerner has investigated pain from many perspectives.

In The News
Dr. Lerner was featured in The Arizona Republic on April 6, 2016. Read Managing Back Pain – Causes, Prevention and Treatment Options by Meghann Finn Sepulveda.