Opioids Should Be Used With Caution For Chronic Noncancer Pain, Neurologists Warn

Weighing in on the ongoing debate surrounding the overuse of prescription painkillers, the American Academy of Neurology (AAN) issued a statement this week calling for new dosing guidelines and best practices to reduce the risk of abuse. 

The AAN position paper was published in the journal Neurology, indicating that the benefits of long-term use of narcotic painkillers are questionable, and calling for doctors to refer chronic pain patients to a specialist if they are taking daily doses of 80-120 mg of morphine-equivalent per day.

The group warns that while there may be some support for the use of prescription opioid painkillers, such as Vicodin, hydrocodone and others, there is “no substantial evidence” for continued use of the narcotics over long periods of time. Simply, the benefits do not outweigh the risks.

Some research has suggested that prolonged use of narcotic painkillers does not improve function without incurring serious risk of overdose, dependence or addiction, especially for chronic pain, like headache, fibromyalgia and lower back pain.

The position paper also highlights best practices for patients and doctors. The group calls on doctors to check prescription data monitoring programs (PDMPs) before prescribing opioids, focusing on guidance for how to monitor patients for early signs of severe adverse events, misuse or disorder, and calls on doctors to use tools to screen patients for risk.

The statement highlights that little evidence is available to support the use of narcotic painkillers for pain therapy longer than 16 weeks, especially for generalized pain, like migraine headaches and other pain.

AAN warns that narcotic painkillers should be used for very few treatments which are non-cancer related pain. Even for serious conditions, like destructive rheumatoid arthritis and sickle-cell disease, the group warns against use, calling for specific guidance on dosing for patients.

The statement recommends alternative pain therapies to narcotic painkillers, including cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.

Painkiller Abuse Epidemic

The AAN is the first medical association to adopt a policy statement regarding opioid painkiller use and prescribing. Washington state was the first state to adopt dosing guidelines, calling for specialist referral when daily doses hit 120 mg morphine-equivalent per day. The Ohio State medical board also issued new guidelines, but their threshold is at 80 mg/day.

At the same time, the Washington State cutoffs are being reevaluated considering the 120mg/day cutoff was determined in 2006. Since then, other studies have been published showing the increased risks of overdose among patients taking 100mg/day or less.

Franklin also touched on a history of the opioid epidemic, which claimed more than 17,000 lives in the U.S. in 2011 alone.

More than 100,000 persons have died, either directly or indirectly, from prescribed opioid painkillers in the U.S. since policies were changed concerning their use in the late 1990s. The highest risk group is people aged 35 to 54 years. Deaths in this age group exceeded the death toll from both firearms and motor vehicle accidents.

Research published last month revealed prescription painkiller overdose deaths continue to be on the rise. A CDC report found prescription drug overdose deaths in the United States nearly quadrupled between 1999 and 2011. More than 40% of overdose deaths in 2011 overall involved narcotic painkillers, like OxyContin and Vicodin.