Daniel P. Alford, MD, MPH; Marc L. Cohen, MD; Eileen E. Reynolds, MD
Acknowledgment: The authors thank the patients for allowing their stories to be shared.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Dr. Alford serves as faculty and course director for safe opioid prescribing and addiction CME programs funded by unrestricted educational grants awarded to Boston University School of Medicine Office of CME by the Substance Abuse and Mental Health Services Administration and the REMS Program Companies as part of the U.S. Food and Drug Administration's ER/LA Opioid Analgesic REMS program. He has not received any direct payment from industry for these activities. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0287.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Eileen E. Reynolds, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Alford: Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118.
Drs. Cohen and Reynolds: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
The increase in overdose deaths from prescription opioids and heroin in the United States over the past 20 years is believed to have resulted from increases in prescription of opioids for management of acute and chronic pain. Managing chronic pain is challenging for primary care clinicians for many reasons, including the lack of evidence to guide practice. The Centers for Disease Control and Prevention published a comprehensive guideline in 2016 to help clinicians with opioid prescribing for chronic pain. In this Grand Rounds, the guideline is reviewed and an expert discusses its application to 3 patients prescribed opioids to treat chronic pain.
Daniel P. Alford, Marc L. Cohen, Eileen E. Reynolds. How Would You Manage Opioid Use in These Three Patients?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2017;166:506–513. doi: 10.7326/M17-0287
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Published: Ann Intern Med. 2017;166(7):506-513.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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