THE CHALLENGE OF TREATING PAIN
The experience of pain brings great physical and emotional suffering with significant societal costs and can interfere with daily life and work. Some 51.6 million U.S. adults live with chronic daily pain, and 17.1 million experience high-impact chronic pain. 1 Pain is even more common in military veterans, particularly those who have served in recent conflicts: 66% reported pain in the previous three months, and 9% reported severe pain. 2 The national cost of pain is estimated at between $560 billion and $635 billion annually. 3 Pain that is unremitting and without adequate treatment can lead to a multitude of problems for the person who suffers, including anxiety, depression, disability, unemployment, and lost income. 3 Certain populations are more vulnerable than others to developing more severe chronic pain and disability, including women, older adults, and individuals from minoritized racial and ethnic backgrounds, 4 who are also at risk for having their pain undertreated. 4 People who lack access to optimal pain care experience more complications in medical and psychiatric conditions. 3 Failure to give adequate care for pain from injury or surgery can
prolong recovery times, leading to hospital readmissions and transition to chronic pain. 3 The challenge of managing acute and chronic pain is complicated by an ongoing public health crisis related to opioid overdose, a category that includes prescription opioids, heroin, and illicitly-produced fentanyl and its analogues. 5 Numerous families have endured tragedy in the form of opioid-related overdose deaths, which doubled from more than 21,000 in 2010 to more than 42,000 in 2016. 5 As of 2021, of the approximately 106,000 drug- related overdose deaths in the United States, over 80,000 of them involved opioids, more than 16,000 of which involved prescription opioids (Figure 1). 6 , 7 Over the past decade, the fatalities have been strongly driven by a proliferation of illicitly produced high-potency synthetic opioids, but prescription opioids and other sedating medications, particularly benzodiazepines, also contributed to fatal overdoses. 8 In all, more than 136 Americans die every day from overdoses that involve a prescription or illicit opioid. Moreover, overdose deaths spiked during the COVID-19 pandemic, particularly deaths involving synthetic opioids. 9
Figure 1: National Drug Overdose Deaths Involving Prescription Opioids
*Among deaths with drug overdose as the underlying cause, the prescription opioid subcategory was determined by the following ICD-10 multiple cause-of- death codes: natural and semi-synthetic opioids (T40.2) or methadone (T40.3). Source: Centers for Disease Control and Prevention, National center for Health Statistics. Multiple Cause of Death 1999-2019 on CDC WONDER Online Database, released 12/2020.
Furthermore, an estimated 4% to 6% of people who misuse prescription opioids transition to non-prescribed opioid and/or illicit opioid use. 13-15 Approximately 75% to 80% of people who use heroin misused prescription opioids first. 13,14 Healthcare practitioners (HCPs) play a key role in facilitating appropriate use of opioids and other sedating medications when prescribed for acute and chronic pain. Pain care is most effective when it combines multiple disciplines and utilizes a broad range of evidence-based pharmacologic and nonpharmacologic treatment options. 16,17 Opioids are associated with small improvements in pain and function versus placebo when used up to six months; however, evidence of longer-term effectiveness is limited, whereas increased harms from use beyond six months appear to be dose dependent. 5 Moreover, nonopioid options may bring equivalent or better patient outcomes with less risk: a comparative effectiveness review of evidence performed by the Agency for Healthcare Research and Quality found no difference in improvement in pain, function, mental health status, sleep, or depression when opioids versus nonopioid medications were used up to six months. 5
These grim statistics illustrate how important it is to keep potential public health consequences in mind when prescribing any type of controlled substance, including opioids. The economic burden of opioid misuse reaches $78.5 billion a year in healthcare, lost productivity, addiction treatment, and criminal justice costs. 10 As of 2023, more than 3 million Americans had an opioid-use disorder (OUD) involving prescription or illicit opioids. 11 Of people age 12 or older in 2019, there were: 5 ● 1.6 million new individuals who misuse prescription pain relievers. ● 949,000 new individuals who misuse prescription sedative-hypnotics. ● 901,000 new individuals who misuse prescription stimulants. Many people who misuse opioids are not receiving regular medical care or prescribed opioids. Most people who are prescribed opioids for pain treatment do not misuse their medications. However, roughly 21% to 29% of patients prescribed opioids for chronic pain do misuse them, and between 8% and 12% of them develop an OUD. 12
Book Code: MDCO1025
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