NIH: Chronic pain requires individualized, patient-centered approach to treatment

Patient-centered care tailored to individuals is needed to treat and monitor the 100 million Americans who live with chronic pain, an independent panel convened by the National Institutes of Health (NIH) has concluded.

“Persons living with chronic pain have often been grouped into a single category, and treatment approaches have been generalized with little evidence to support this practice,” said Dr. David B. Reuben, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “Chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, multifaceted approach.”

While the adverse effects of opioids are well-documented, the panel noted that there are not enough studies that evaluate the long-term safety of opioids, and no long-term studies exist that assess the effectiveness of opioids in relation to pain, function, and quality of life.

“We have inadequate knowledge about treating various types of pain and how to balance effectiveness with potential harms. We also have a dysfunctional health care delivery system that promotes the easiest rather than the best approach to addressing pain,” noted Dr. Reuben.

Numerous obstacles exist to implementing individualized, patient-centered care, the panel noted. Insurance plans may not offer effective alternatives to opioid drugs as a first-line treatment for pain, and some plans may not cover team-based approaches that promote holistic, comprehensive care.

In addition, primary care practices don’t often have access to experts that might help alter the course of treatment, such as pain management specialists, and there is insufficient data on specific drug characteristics to guide clinical care, the panel noted.

“Clearly, there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches,” stated Dr. Reuben. “The challenge is to identify the conditions for which opioid use is most appropriate, the alternatives for those who are unlikely to benefit from opioids and the best approach to ensuring that every patient’s individual needs are met by a patient-centered health care system.”

NIH’s Office of Disease Prevention convened a seven-member workshop in September of specialists in gerontology, rheumatology, internal medicine, psychiatry, addiction medicine, nursing, health education, biostatistics, and epidemiology to review available scientific evidence on the role of opioids in the treatment of pain management.

The panel’s report includes an evidence report, expert presentations, audience input, and public comments. View the report here.