In the United States, the number of patients with chronic pain exceeds cancer, diabetes and heart disease combined [1,2]. It is estimated that 100 million people in the United States are suffering from chronic pain [1,2] and it is here that people consume more opioid than any other country in the world, with more than 70 people every day now dying from opioid overdoses [3,4]. According to the Centers for Disease Control, nearly two million people misused or were dependent on prescription opioids in the United States in 2014 . As of 2011, 75% of the world's opioid prescription drugs are prescribed in a country that makes up less than 5% of the world's population [1-4]. But patients are in genuine pain, particularly those with chronic pain from chronic painful conditions such as degenerative disc disease or age-related spinal stenosis and these patients still require treatment.
Here five simple ways both providers and patients can take a step in the right direction to address chronic pain:
- Patients need to be part of the plan of treating chronic pain. Patients need to speak up about their pain and potential risks that may place them at higher risk of an adverse event such as an opioid overdose and if they don’t know what that may be they need to ask those hard questions. Also, patients should also self-track their pain and talk to your loved ones and doctor to ensure there is a clear understanding of all risks, benefit and all alternatives of their treatment.
- Make a pain management plan for both good and bad days. Assessing and treating pain requires a multifaceted approach that emphasizes comprehensive assessment and treatment that involves patients, physicians and caretakers. This is now being reflected in clinical guidance. The CDC now recommends that we need to ask patients if they enjoy their life as well as how severe their pain is [5,6].
- Doctors and patients both need to start by having more meaningful conversations with patients with chronic pain or addiction or both. The most important tool for addressing addiction is communication. Patients should be encouraged to be open with their care providers, working with them on an effective pain management plan and addressing warning signs of addiction promptly and physicians need to be clear about the risks.
- Patients need to understand that they do not need to have an opioid addiction to be at risk for an overdose. For example, if people take benzodiazepines (such as alprazolam) or sleep aids (such as zolpidem), if they misuse other drugs (like heroin or marijuana), or if they drink alcohol while taking a prescription opioid, the combination can have deadly consequences. Any drug that slows down breathing increases the risk, and people who have kidney disease or liver disease are at higher risk because they may not break down the drugs the way they should.
On the contrary, when opioids are taken as prescribed by a physician to manage pain, overdose is unlikely. They can treat pain effectively patients know how to use them safely and responsibly — physicians and pharmacists can help achieve this through counseling and consultations. Problems occur when people begin taking more tablets than prescribed or taking them more often than recommended. The risk of overdose also increases when people take the drugs for reasons other than pain relief — to help them sleep, for instance, or to self-medicate anxiety or depression.
- Caretakers of patients taking opioid painkillers should be counseled about the warning signs of an overdose. If the person’s breathing slows down, or pupils become tiny, or lips or fingernails develop a bluish tint, or skin becomes pale and clammy, or heartbeat becomes slow or irregular, these are signs of a possible overdose.  Caretakers should call emergency services or, if available, administer naloxone, an opioid antagonist that temporarily reverses the effects of opioids for 20 to 30 minutes.
Congress recently passed the Comprehensive Addiction and Recovery Act (CARA), a bipartisan act that will potentially allow for more education research, treatment and funding for the opioid addiction . But we still need to do more. We now need to focus on solutions rather than the problems. Because those in pain still need to be cared for while we try to curb a growing addiction problem.
1. Institute of Medicine report from the committee on advancing pain research, care, and education: relieving pain in America, a blueprint for transforming prevention, care, education and research. The National Academies Press, 2011. Available at:
http://books.nap.edu/openbook.php?record_id=13172&page=1. (accessed 19 August 2016).
2. Simon LS. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Journal of Pain & Palliative Care Pharmacotherapy 2012;26;197–198. http://dx.doi.org/10.3109/15360288.2012.678473
3. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999–2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html
4. Centers for Disease Control and Prevention. Why guidelines for primary care providers? Available at: http://www.cdc.gov/drugoverdose/prescribing/guideline.html (accessed 19 August 2016)
5. Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2014. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
6. CDC Guideline for Prescribing Opioids for Chronic Pain. http://www.cdc.gov/drugoverdose/prescribing/guideline.html
7. World Health Organization. Information sheet on opioid overdose. November 2014. http://www.who.int/substance_abuse/information-sheet/en/
8. S.524 – Comprehensive Addiction and Recovery Act of 2016. https://www.congress.gov/bill/114th-congress/senate-bill/524/text