How effective is long-term opioid therapy for chronic pain?
Recently, the National Institutes of Health (NIH) commissioned the Agency for Healthcare Research and Quality (AHRQ) to conduct a systematic review* of the current evidence on long-term opioid therapy for chronic pain. The results were used to inform the NIH workshop, Pathways to Prevention: The Role of Opioids in the Treatment of Chronic Pain. A key finding of the AHRQ report was that the confidence level in the efficacy of long-term therapy was ranked “no higher than low” due to methodological shortcomings and imprecision.
Other findings of the report were that:
- Long-term opioid therapy was associated with increased risk of abuse, overdose, fracture, myocardial infarction, and markers of sexual dysfunction, with several studies showing a dose-dependent association.
- Methodological shortcomings—such as varied definitions and measures—made it difficult to draw conclusions, as shown by:
- In 10 uncontrolled studies, rates of opioid abuse were 0.6-8% and rates of dependence were 3-26% in primary care settings, but definitions and measures varied.
- Rates of aberrant drug-related behaviors ranged from 5-37%.
- To date, no study has evaluated effects of long-term opioid therapy versus no opioid therapy.
To read the report, learn more about safe opioid prescribing, or to take free CME in this area, go to: www.COPEREMS.org
The University of Washington (UW) School of Medicine’s COPE (Collaborative Opioid Prescribing Education)-REMS offers online training for all healthcare providers.
The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Washington School of Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The COPE-REMS educational activity is supported by an independent educational grant from the ER/LA Opioid Analgesic REMS Program Companies. Please see www.er-la-opioidREMS.com for a listing of the member companies. This activity is intended to be fully compliant with the ER/LA Opioid Analgesic REMS education requirements issued by the US Food & Drug Administration.
CPCA Patient Centered Health Home Initiative
A health home is an approach to delivering primary care that uses a ‘whole person’ orientation to provide comprehensive health care by facilitating an active partnership between patients, their family, and their primary care provider team to provide high quality, timely care in a coordinated and consistent way. The goal of this approach is to ensure that patients and providers work together as partners, enabling the right care to be delivered at the right time with the right people engaged in the discussion.
The California Primary Care Association (CPCA) has developed a Patient-Centered Health Home (PCHH) initiative to support community health centers (CHCs) to achieve patient centered health home, improve health outcomes, and position CHCs for ongoing participation in primary care delivery under health reform. Through this initiative CPCA provides practice coaching, training and education and technical tools that facilitate practice transformation.
CPCA Patient-Centered Health Home (PCHH) practice coaches provide tailored assistance to facilitate practice transformation and guide community clinics and health centers through the PCHH recognition process. CPCA practice coaches are experienced quality improvement professionals with deep roots and dedication to community health. Coaches create a custom scope of work based on individual health center needs and resources. With a base hourly rate of $160, PCHH practice coach services can include:
- Practice Assessment & Implementation Plan Development
- On-going Practice Transformation Facilitation
- Workflow Redesign Recommendations
- Mock NCQA Survey
For more information, please contact Tina Canupp at firstname.lastname@example.org.