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Pain and Opioid Updates

Apr 13, 2023 10:55 am

Today, the CDC and FDA provided new updates on the scope of pain in the USA and guidance on the use of opioids.

MMWR April 14, 2023

The CDC's Morbidity and Mortality Weekly Report estimated that in 2016, 50 million adults in the United States experienced chronic (≥3 months) pain, with a substantial health care costs and lost productivity. By 2021, the impact of chronic pain rose to 51.6 million persons (20.9%)  in the USA, with 6.9% (17.1 million) experiencing  chronic pain that results in substantial restriction to daily activities (high-impact chronic pain), most prevalent in non-Hispanic American Indian or Alaska Native adults, adults identifying as bisexual, and adults who were divorced or separated.  (Editors note: another recent report demonstrates that LGBTQ+ individuals have higher pain scores)

These findings were drawn from the National Health Interview Survey (NHIS) from the 2019–2021 NHIS to provide updated estimates of the prevalence of chronic pain and high-impact chronic pain among adults in the United States and within population groups defined by demographic, geographic, socioeconomic, and health status characteristics. New findings from this analysis include that non-Hispanic American Indian or Alaska Native (AI/AN) adults, adults identifying as bisexual, and adults who are divorced or separated are among the populations experiencing a higher prevalence of chronic pain and high-impact chronic pain.

Chronic pain is debilitating, affects daily work and life activities for many adults in the United States and has been linked with depression, Alzheimer disease and related dementias, higher suicide risk, and substance use and misuse. 

FDA Drug Safety Communication on Opiates April 13, 2023

FDA has updated the prescribing information for all opioid pain medicines to provide additional guidance for safe use and to help reduce unnecessary prescribing.

The FDA notes there has been a substantial overall decrease in the number of dispensed prescriptions for opioid pain medicines, yet overdose deaths involving prescription opioids have remained steady, with 16,706 deaths in 2021. However, these statistics likely underestimate the role of prescription opioids in contributing to overall opioid-related overdose deaths. Data suggest some patients who are prescribed opioid pain medicines may progress to nonmedical use of opioids and other controlled substances, contributing to the number of opioid-related overdoses. The impact of the opioid crisis extends beyond deaths and includes health consequences and harm to families.

Recent data also suggest that:

  • many acute pain conditions treated in the outpatient setting require no more than a few days of an opioid pain medicine (adjusted for underlying cause and individual patient factors).
  • patients who use opioid pain medicines after surgery often have unused tablets, which may pose a risk of accidental use, misuse and abuse, addiction, and overdose, including by children and teenagers
  • extended-release/long-acting (ER/LA) opioid pain medicines have unique risks and should be used only for those with severe and persistent pain

Opioid-induced Hyperalgesia (OIH). Based on our review of available data, FDA has also determined that a new warning is needed about opioid-induced hyperalgesia (OIH), which is when an opioid that is prescribed and taken for pain relief causes an increase in pain (called hyperalgesia) or an increased sensitivity to pain (called allodynia). Although OIH can occur at any opioid dosage, it may occur more often with higher doses and longerterm use. This condition can be difficult to recognize and may result in increased opioid dosages that could worsen symptoms and increase the risk of respiratory depression.  If a patient is suspected to be experiencing OIH, carefully consider an appropriate decrease in dose of the current opioid pain medicine or safely switching them to a different opioid product, if tolerated. Advise patients about the risk of OIH and tell them to never increase the opioid dosage without first consulting a health care professional, because this could worsen the pain and increase the risk of respiratory depression. 

Information in the Boxed Warning, FDA’s most prominent warning, for all IR and ER/LA opioid pain medicines will be updated and reordered to elevate the importance of warnings concerning lifethreatening respiratory depression, and risks associated with using opioid pain medicines in conjunction with benzodiazepines or other medicines that depress the central nervous system (CNS)

The full FDA Drug Safety Communication can be viewed here.



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The author has no conflicts of interest to disclose related to this subject