Pain Management: Risk Management Issues

Course overview

The number of patients with chronic pain is estimated to range from 50 million to 116 million. Estimates vary, but it is believed that between 15% and 25% of all visits to primary care office practices are for treatment of chronic pain or result in a prescription for opioids. Additionally, the rate of death from overdoses of prescription medication rose from 2,900 in 1999 to 16,000 in 2010 (Indiana Guidelines). This has made overdoses the leading cause of accidental death in the United States. The CDC reported that prescription drug abuse was epidemic in the U.S. in January 2012. The CDC pegged the number of deaths due to drug overdose at 27,000 in 2007, but it was not clear whether these were all related to prescription drugs. There is also widespread nonmedical use (i.e., not prescribed for the individual's use) and abuse of prescription drugs. In 2014, 27.0 million people aged 12 or older had used an illicit drug in the past 30 days, which corresponds to about 1 in 10 Americans (10.2%). In this activity, we address risk management with pain management techniques for primary care providers. It is not intended for pain management specialists. Furthermore, it will only address chronic non-cancer chronic pain (CNCP) rather than pain resulting from malignancies or in terminal patients. We will cover the topics of pill mills; duty to warn; issues in initiating therapy for chronic pain; initial treatment; follow-up and monitoring the patient; and cessation of therapy. After completing this activity, practitioners should be able to: describe the pitfalls common to prescribing opioids; describe the steps necessary to initiate and monitor therapies for pain management with opioids; and describe the ways in which therapy with opioids may safely be terminated.