Rapid onset opoid article

[Guest guest]

Introduction

Chronic pain conditions produce enormous health consequences in our society,

and are among the most frequent sources of medical care utilization and

disability in the United States. Approximately 50 million adults in the

United States suffer from persistent or recurrent pain that is sufficiently

intense to affect their lives.[1] Chronic pain often impairs quality of life

(QOL) and is associated with decreased physical, emotional, and social

well-being. Patients who report significant impairments in their QOL often

experience depression, sleep disturbance, and fatigue.[2-4]

Because the impact of chronic pain on QOL is multidimensional in nature (e.g

, physical, emotional, and social well-being can be affected), pain is only

one of many issues that must be addressed in the management of patients with

chronic pain. Therefore, effective pain management strategies frequently

require both pharmacologic and nonpharmacologic interventions and a team

approach that involves patients, families, and healthcare providers

[5]Despite the development of efficacious pharmacologic and nonpharmacologic

interventions for chronic pain, the undertreatment of pain is common,

particularly among the noncancer patient population. Multiple clinician-,

patient-, and system-related factors contribute to inadequate pain

management. One barrier involves the fact that opioids are the strongest

pain relievers available and that their potential for abuse requires that

they be classified as scheduled drugs by the US Drug Enforcement Agency

(DEA) under the Controlled Substances Act of 1970.

The stigmatization of opioid use is often compounded by healthcare provider

fears of dealing with the highly regulated distribution system for opioid

analgesics.[6,7] Of importance, most clinicians treating chronic pain

recognize that the majority of suffering patients are not substance abusers.

However, these sociocontextual influences may hinder effective pain

management. Such concerns will be particularly acute when more rapid-onset

opioids are approved by the US Food and Drug Administration and marketed by

pharmaceutical companies. Although rapid-onset opioids are unlikely to be

abused by pain patients without a history of substance abuse, they are

likely to be attractive to substance abusers. Thus, resulting scrutiny about

the risk potential for these drugs is likely to be intensified as new drugs

come on the market.

Other complicating issues leading to the undertreatment of chronic pain

conditions involve misconceptions about addiction to opioids and patient

fears about dependency and addiction. Concerns that patients will become

addicted to opioids during long-term therapy often stem from the confusion

between physical dependence (tolerance) and the psychological dependence

(addiction) that manifests as drug abuse. This misunderstanding, along with

provider- and system-related barriers to opioid prescription and use, can

lead to the undertreatment of chronic pain.

Despite these trends, the medical community is slowly overcoming the

barriers to effective pain management, especially in the noncancer patient

setting. The DEA and 21 health organizations, including the American Medical

Association, have jointly written a consensus statement that supports the

use of opioid analgesics for the treatment of pain while recognizing their

potential for abuse.[8] In addition, many professional organizations,

including the American Society of Addiction Medicine,[9] American Academy of

Pain Medicine and American Pain Society (APS),[10] and Federation of State

Medical Boards,[11] have independently issued consensus statements that

support the use of opioids in select patients with chronic noncancer pain.

These developments are based on accumulated evidence indicating that

patients treated with opioids for chronic noncancer pain show improvement in

analgesia and functioning.

Although state and local laws restrict the use of opioid analgesics,

prescribers who are aware of and adhere to guidelines can use these

effective agents in the management of chronic pain. The Joint Committee on

Accreditation of Healthcare Organizations (JCAHO), which accredits nearly

80% of the hospitals in the United States, has developed new standards for

assessing and managing pain for patients and has begun monitoring compliance

with these standards.[12] Specifically, the new JCAHO standards (Standard RI

2.160) call upon healthcare organizations to establish policies and

procedures that support the appropriate prescription and ordering of

effective pain medications.[12]