David B. Reuben, MD; Anika A.H. Alvanzo, MD, MS; Takamaru Ashikaga, PhD; G. Anne Bogat, PhD; Christopher M. Callahan, MD; Victoria Ruffing, RN, CCRC; David C. Steffens, MD, MHS
Note: A list of the workshop panelists, speakers, working group members, and sponsors is provided in the Appendix.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2775.
Requests for Single Reprints: David B. Reuben, MD, Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095.
Current Author Addresses: Dr. Reuben: Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095.
Dr. Alvanzo: Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 8069, Baltimore, MD 21287.
Dr. Ashikaga: University of Vermont, 105 Carrigan Drive, Medical Biostatistics, 27 Hills Building, Burlington, VT 05405.
Dr. Bogat: Department of Psychology, Michigan State University, 107E Psychology Building, East Lansing, MI 48824-1116.
Dr. Callahan: Indiana University Center for Aging Research, Regenstrief Institute, 410 West 10th Street, Building HS2000, Indianapolis, IN 46202.
Ms. Ruffing: Johns Hopkins University, 5501 Hopkins Bayview Circle, JHAAC 1B1, Baltimore, MD 21224.
Dr. Steffens: University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1410.
Author Contributions: Conception and design: D.B. Reuben, G.A. Bogat, C.M. Callahan, D.C. Steffens.
Analysis and interpretation of the data: D.B. Reuben, T. Ashikaga, G.A. Bogat.
Drafting of the article: D.B. Reuben, A.A.H. Alvanzo, T. Ashikaga, G.A. Bogat, C.M. Callahan, V. Ruffing, D.C. Steffens.
Critical revision of the article for important intellectual content: D.B. Reuben, T. Ashikaga, G.A. Bogat, C.M. Callahan, D.C. Steffens.
Final approval of the article: D.B. Reuben, A.A.H. Alvanzo, T. Ashikaga, G.A. Bogat, C.M. Callahan, V. Ruffing, D.C. Steffens.
Statistical expertise: T. Ashikaga, G.A. Bogat.
This National Institutes of Health (NIH) Pathways to Prevention Workshop was cosponsored by the NIH Office of Disease Prevention (ODP), the NIH Pain Consortium, the National Institute on Drug Abuse, and the National Institute of Neurological Disorders and Stroke. A multidisciplinary working group developed the workshop agenda, and an evidence-based practice center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the workshop discussion. During the 1.5-day workshop, invited experts discussed the body of evidence, and attendees had opportunities to provide comments during open discussion periods. After weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepared a draft report that identified research gaps and future research priorities. The report was posted on the ODP Web site for 2 weeks for public comment. This article is an abridged version of the panel's full report, which is available at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#final report.
Table. Panel Recommendations
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J Walden Retan MD
The Pain Clinic, Cooper Green/Mercy Health Services, Birmingham, AL
March 14, 2015
Withdrawal of therapy?
“…and patients who do not meet the mutually agreed-on clinical outcomes should be considered for discontinuation of opioid therapy.”What?Patients come to pain clinics to get their pain reduced. Any other clinical outcome is gravy. Any other clinical outcome that is set down and identified as a therapeutic goal, to be attained or opiates will be withdrawn, isn’t “mutually agreed.” It’s coerced by a physician and tolerated by a patient who has no choice, no leverage in the negotiation. “…many speakers agreed on the need for an ‘exit strategy’…”Why?Shouldn’t pain be treated as long as it’s there?
Reuben DB, Alvanzo AA, Ashikaga T, et al. National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Ann Intern Med. 2015;162:295–300. doi: https://doi.org/10.7326/M14-2775
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Published: Ann Intern Med. 2015;162(4):295-300.
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