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  • CDC Reiterates Limits of Opioid Prescribing Guideline

    The US Centers for Disease Control and Prevention (CDC) wants to make it clear: its guideline on the use of opioids for the treatment of chronic pain is not intended to apply to pain related to cancer treatment, palliative care, or end-of-life care. The clarification is consistent with messaging used by APTA in its #ChoosePT opioid awareness campaign and its MoveForwardPT.com consumer-focused website.

    In a February 28, 2019, letter from CDC Chief Medical Officer Deborah Dowell, MD, MPH, the agency restates its intentions around the prescribing guideline, issued in 2016, that recommends nonopioid approaches including physical therapy as a preferred first-line treatment for some—but not all—types of chronic pain.

    "The Guideline was developed to provide recommendations for primary care physicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care," Dowell writes. "Because of the unique therapeutic goals, and balance of risks and benefits with opioid therapy in such care, clinical practice guidelines specific to cancer treatment, palliative care, and end-of-life care should be used to guide treatment and reimbursement decisions regarding use of opioids as part of pain control in these circumstances."

    The letter was written in response to concerns voiced by the National Comprehensive Care Network, the American Society of Clinical Oncology, and the American Society of Hematology that some payers were balking on paying for opioid prescriptions in circumstances outside the scope of the CDC guidelines.

    Even without the clarification, the original guideline is explicit in its intent, which appears in the first sentence of the document and again when the CDC describes the scope of the guideline and intended audience. Similarly, APTA makes it clear that doctor-prescribed opioids are appropriate in some cases and has included that message in both its #ChoosePT webpage and its public service announcement related to the opioid crisis.

    "The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management," Dowell writes. "Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options."

    Comments

    • Chronic pain people like myself are suffering needlessly because of those whom choose to abuse medication. It should be doctors call,not the CDC or govt

      Posted by B.smith on 4/12/2019 6:24 PM

    • * 7 back operations before 20. * Altered lifestyle (pain) for 40 thereafter. * 3 more back operations between age 45 - 49. * One operation resulted in slashed spinal canal and massive nerve damage. * Lived with increased draining chronic pain for another 5 years while experimenting with numerous treatments , did not want pain medications. * As last resort I met with doctor and finally succumbed to pain medication . * Started with 150 mgs combination of OxyContin/OxyCodone, cut to 120 mgs and then to 90 mgs , initiated by myself. * Then the decision was made for my doctor to cut to a total of 60 mg. Surgeries were discussed but not an option due to concern of the spinal canal mishap and my doubts . * I live in pain ...... * Leads me to wonder if doctors have a revised and “ handcuffed “ Hippocratic Oath , paraphrased below: “ to use treatment to help the sick based on ability and judgement ... ( someone else’s judgement) . “abstain from wrongdoing or harm ( to myself ) . * I am not unique with this ordeal .

      Posted by C. David Garvin on 4/15/2019 5:58 PM

    • Those guidlines were enforced as if they were laws. Some states went above and beyond the CDCs guidelines, while some physicians opted out of prescribing at all. This left pain patients without any recourse at all. At the same time the continuous malignant language in mass media, and marketing sites liek this one, stigmatized, blamed and conflated all pain patients with craven drug addicts. Physical Therapists as health professionals, chose to use the so called opioid epidemic to market their services, by misleading and cherry picking information, in order to elevate their business, and increase profits. The tone of this article suggests they are utterly unaware of what their patients are dealing with. PT works fine for some conditions, especially post surgical, or for rehabilitation after an accident. There is virtually no credible research on the various pain conditions, and in some cases Physical Therapy can be dangerous or lead to further injury. Of course no research has been done on those issues. Another area where Physical Therapy has not been studied, is when they postpone a surgery a patient needs. Patients who are vulnerable, and desperate, turn to Physical Therapy to avoid surgery. In many cases all that they did was subject themselves to a year or more of appointments, frustration, and pain, and they still needed the surgery. They did not have access to real medical advice. No research was done on this postponement, and further debilitation, due to trying physical therapy for a condition that can only be made worse. Desperate pain patients are reaching out on these sites. They were told by industry funded advocacy groups to "Tell their story." These patients should not have to plead their cases on sites like this or the CDC Website. Most are suffering horribly, like the one who commented above. Many of these pain patients had multiple surgeries, some had infections and amputations. These are among the people who have been denied pain treatment, due to the misreporting of science, facts, and the advertising done by groups like this. There is no evidence that physical therapists can cure the ongoing intractable pain, these patients endure day in and day out. They start to sound insane, because they don't sleep. Their sleep is interrupted by their intractable chronic pain. They endure years of this, while they are ignored by sites like this. No amount of physical therapy, acupuncture, marijuana or thinking good thoughts can relieve their pain. Yet a health provider is using their distress to market their services. There is no mention of the criticisms of the CDC guidelines here, or the damage they have done. Clearly Physical Therapists are unaware that some of their patients were denied pain care, a clear diagnosis, or were forced to undergo physical therapy, even though it would not cure their pain or even make it manageable. We have a conspiracy of silence here, since the misery of these discarded patients can be profitable.

      Posted by Kathy Cooper on 4/16/2019 1:11 PM

    • You state, "The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management." Well, that is exactly what your guideline did! Some of the statistics on your website are also not accurate. The numbers of people dying are not the same for people who take prescribed opiates vs heroin laced with Fentanyl and not prescribed Fentanyl, Fentanyl that is man made. The total numbers of people dying should be separated by: prescription opioids/ Heroin with Fentanyl. There is a big difference. Chronic pain patients should matter and it seems they don't. My grandfather who worked hard all his life was on opiod medication for over 15 years. He didn't abuse it, he took it as prescribed and it was not anywhere near 90 MME, that dose wouldn't have touched his pain. He just retired in 2017 and he was enjoying life and being outside working on his yard, planting flowers, trimming the bushes, he even added a chair for himself to sit in the back of the yard under the trees. He was 73 and had alot of life left in him, until his doctor was to scared and feared he'd lose his license if he kept prescribing my grandfather his opioid medication. His dose was also not anywhere near 90MME. Everybody handles pain differently, people are built differently, there should not an across the board amount to prescribe, especially that low for chronic pain patients that have been taking their medication at a higher dose for years, which was another reason his doctor was scared, because the amount he was prescribing was over 90MME. He started to wean my grandpa off of his medication and it was so heart breaking to watch him just start to deteriorate. He couldn't walk on his own anymore, he needed a walker, he started sitting in his chair to watch TV, which was not the norm for him. The color started to drain from his face, he started to look pale, like a chalky pale, he had very dark bags under his eyes and he just looked awful and he was no longer my grandpa that was full of life and loved to make people laugh. He begged his pain doctor to please help him get out of the debilitating pain he was in and to give him his medications back. The doctor had tears in his eyes also, because he has treated my grandpa for over 20 years. His reply to my grandpa was that he was so very sorry he couldn't risk losing his license. My grandfather was no longer the same person he once was, it was so hard for our family to watch him continue to go downhill. My grandma ran to the store on Sunday afternoon as she always did and when she got back home my grandpa was not in his chair, she went to go find him and calling his name, she opened the door to their bedroom and there she found my grandpa on their bed, no longer alive. He had shot himself. Our whole family took it hard and to see my grandma hurt so badly. This happened all because of the guidelines that the CDC put in place. He worked so hard his whole life and didn't even get to enjoy his retirement. This is happening to chronic pain patients all across the US and nothing is being done about it. It seems to me that saving the lives of the people that chose to take the medication the incorrect way and end up dying are more important than the people that depend on the opioid medication to live their lives and be a productive member of society and that is so very sad. My grandfather taking his life could have been prevented if the CDC and government thought of everyone when coming up with their guidelines and rules. The FDA, the DEA, the AMA have all requested the guidelines be changed to address chronic pain patients and the doctors, so that more chronic pain patients don't have to suffer the way my grandpa did. I read the article above and thats all that was written about the issue and I really hope that was just a start to make it a better. Please look into making it public that the 90mme guidelines are not meant for chronic pain patients and let the doctors treat their patients. If you saw this from my side, you would see the opioid medication works when taken correctly!

      Posted by N. Lanier on 4/17/2019 5:37 AM

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