Background

Chronic pain is a major public health problem, which is estimated to affect more than 100 million people in the United States and about 20–30% of the population worldwide. The prevalence of persistent pain is expected to rise in the near future as the incidence of associated diseases (including diabetes, obesity, cardiovascular disorders, arthritis, and cancer) increases in the aging U.S. population.

Opioids are powerful analgesics which are commonly used and found to be effective for many types of pain. However, opioids can produce significant side effects, including constipation, nausea, mental clouding, and respiratory depression, which can sometimes lead to death.

In addition, long-term opioid use can also result in physical dependence, making it difficult to discontinue use even when the original cause of pain is no longer present. Furthermore, there is mounting evidence that long-term opioid use for pain can actually produce a chronic pain state, whereby patients find themselves in a vicious cycle, where opioids are used to treat pain caused by previous opioid use.

Data from the Centers for Disease Control and Prevention indicate that the prescribing of opioids by clinicians has increased threefold in the last 20 years, contributing to the problem of prescription opioid abuse.¹ Today, the number of people who die from prescription opioids exceeds the number of those who die from heroin and cocaine, combined.

Challenges

Health care providers are in a difficult position when treating moderate to severe chronic pain; opioid treatments may lessen the pain, but may also cause harm to patients. Additionally, there has not been adequate testing of opioids in terms of what types of pain they best treat, in what populations of people, and in what manner of administration. With insufficient data, and often inadequate training, many clinicians prescribe too much opioid treatment when lesser amounts of opioids or non-opioids would be effective. Alternatively, some health care providers avoid prescribing opioids altogether for fear of side effects and potential addiction, causing some patients to suffer needlessly.

Workshop Goals

The workshop sought to clarify:

• Long-term effectiveness of opioids for treating chronic pain
• Potential risks of opioid treatment in various patient populations
• Effects of different opioid management strategies on outcomes related to addiction, abuse, misuse, pain, and quality of life
• Effectiveness of risk mitigation strategies for opioid treatment
• Future research needs and priorities to improve the treatment of pain with opioids.

Sponsoring NIH Institutes, Centers, and Offices

The workshop was co-sponsored by:

• National Institute on Drug Abuse
• National Institute of Neurological Disorders and Stroke
• NIH Office of Disease Prevention
• NIH Pain Consortium

1. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2000–2010 on CDC WONDER Online Database. Extracted February 11, 2013.