In June 2011, the Institute of Medicine published Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. This seminal report clearly states that 100 million Americans live with chronic pain and that the annual cost of treating chronic pain, counting direct healthcare costs and lost productivity, is more than $500 billion.
The US population is right at 320 million. That means that 1 in 3 Americans lives with chronic pain, including diseases such as fibromyalgia, ME/CFS, migraines, TMJ and others. Some of us are able to function well even with the pain – we work, we have social lives, we volunteer, we participate. Others, unfortunately, are totally incapacitated, unable to work and dependent on others to care for them. There is simply no way to quantify the cost in human terms – loss of jobs, relationships, sense of self and even life itself. The suicide rate for those in chronic page is 2.5 to 4 times greater than that of the general population.
The US Centers for Disease Control and Prevention defines epidemic as “the occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time.” (Often, but not always, the word “epidemic” is used to describe an infectious disease, such as the flu.) Given the number of people (100 million) and the cost (>$500 billion in economic terms and indefinable in humanistic terms), you would think that chronic pain would be identified as an epidemic. It is not.
There are many ways to deal with chronic pain, including self-management practices such as nutrition, supplements, exercise, meditation, lifestyle changes and so on. Many people find that complementary and alternative therapies such as acupuncture, massage, aromatherapy, etc., are helpful. For a few, injections and/or surgery may provide some relief. And then there are the pharmacologic resources, including opioids.
In September of last year, the Centers for Disease Control announced their plan to develop guidelines for opioid prescribing in an effort to address the “prescription painkiller overdose epidemic.” The CDC website states that in 2013 more than 16,000 people in the US died from prescription painkillers and that nearly 2 million Americans (12 or older) either abused or were dependent on opioids. Certainly, every one of those 16,000 deaths is a tragedy and I would hope to never hear of another person dying from an accidental overdose, an adverse reaction, or an illicitly received medication. Addiction is a real disease that deserves attention and resources.
But I do not believe these guidelines are the answer.
(Click on the PDF icon to view the document.)
It’s a long document (56 pages). The twelve (12) recommendations start on page 16.
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I do believe that if approved, the proposed CDC guidelines will have serious negative impact on many people who live with chronic pain. The Notice posted in the Federal Register states that “The Guideline is not a federal regulation; adherence to the Guideline will be voluntary.” The reality is that CDC guidelines lead to policy (including healthcare provider licensing boards and insurance reimbursement policies) and become the standard of care for healthcare providers.
Go to this website https://www.federalregister.gov/articles/2015/12/14/2015-31375/proposed-2016-guideline-for-prescribing-opioids-for-chronic-pain#open-comment and voice your opinion.
Comments are due by Wednesday, January 13, so don’t delay.
Cindy Leyland is ProHealth's Fibromyalgia Editor. Cindy also serves as the Director of Program Operations at the Center for Practical Bioethics and the PAINS Project Director. She lives in Kansas City with her husband, enjoys hiking, reading, volunteering with Synergy Services and being Gramma Cinny.