NIH panel: Patient-centered approach needed for pain management

pain managementThose suffering from chronic pain need individualized care strategies to be best served by their physicians, according to the recent findings of an expert panel convened by the National Institutes of Health (NIH).

“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 Reuben, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said in a NIH news release.

“Chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, multifaceted approach.”

The eight-member panel reported that chronic pain is most often treated with opioids, though long-term studies supporting the effectiveness of this course of treatment related to pain, functionality or quality of life are lacking. The panel also recommended more research be done on the long-term safety of opioids and as well as multidisciplinary approaches to pain management that do not rely predominantly on opioids.

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

Chronic pain affects more Americans than diabetes, heart disease and cancer combined, according to the NIH, and is cited as the most common reason Americans access the health care system. Approximately 76.2 million Americans, or one in every four, have suffered from pain that lasts longer than 24 hours.

The panel’s recommendations highlighted several areas of promising research, including using individual patient genetics in tailored pain management. Since most opioids are metabolized by highly variable CYP450 enzymes, response to painkillers can vary greatly from patient to patient.

For example, patients reporting little or no relief from opioid painkillers may seem to a provider to be addicted and simply seeking more. However, in some patients with specific genetic variants, the body’s slower formation of a painkiller’s more active component can lead to tolerance, despite inadequate pain relief, and cause the inappropriate labeling of a patient as a drug seeker.

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