Opioid Use for Treatment of Chronic Pain: An Overview and Treatment Guideline for Injured Workers Responses.

Corresponding Author: Sridhar V. Vasudevan, MD, W180N8085 Town Hall Rd, Menomonee Falls, WI 53051-3518; phone/fax 262.285.3638; e-mail [email protected]. Challenges of Managing Individuals With Chronic Pain Acute pain that accompanies an injury, illness, or surgical procedure usually resolves with appropriate treatment—or without treatment— in 6 to 8 weeks. Chronic pain, however, generally serves no biological purpose, persists beyond its healing period for the condition, and leads to significant functional decline.1 It frequently is described as “pain that occurs on at least half the days for 6 months or more,2 and the prevalence of people experiencing chronic pain in the United States is estimated at nearly 11.2% of the adult population.3 Since the early 1960s, chronic pain has been recognized as a biopsychosocial problem, which led to the development of multidisciplinary pain management programs. But despite copious research on the effectiveness of programs that use multimodal treatment for chronic pain, and the dearth of evidence for single modality approaches such as opioids, injection/interventional procedures, and surgery, over the past 2 decades there has been a decline in these programs in the United States (while at the same time such programs are developing in other parts of the world). Individuals with chronic pain frequently demonstrate several “Ds”: Dramatic verbal and nonverbal pain behaviors, Disuse of body parts with pain, Deconditioning, eg, generalized disability that exceeds the degree of identifiable objective medical findings, Depression, and Drug misuse/abuse, especially with excessive use and dependence on opioids.1 Opioid misuse and abuse leading to deaths is an urgent problem facing the American public, and prescription of opioids by physicians is one of several reasons attributed to the sudden escalation of this crisis. To address the issue, the Centers for Disease Control and Prevention (CDC) issued its Guideline for Prescribing Opioids for Chronic Pain in March 2016. Prior to that, however, the members of the Wisconsin Worker’s Compensation Health Care Provider Advisory Committee (HCPAC) raised concerns regarding excessive prescribing of opioids for patients injured at work who are covered by the Wisconsin Worker’s Compensation System. This commentary describes the complexity and challenges of pain management, especially chronic pain, and the Committee’s development of Chronic Opioid Clinical Management Guidelines for Wisconsin Worker’s Compensation Patient Care. Sridhar V. Vasudevan, MD, for The Health Care Advisory Committee of the Wisconsin Worker’s Compensation Division, Department of Workforce Development Opioid Use for Treatment of Chronic Pain: An Overview and Treatment Guideline for Injured Workers