ASRA Provides Comments to CDC Regarding Opioids and Substance Use Disorder
ASRA responded to the CDC's request for comments on and experiences with pain and pain management with a letter sent on May 22, 2020. In the letter, ASRA cites evidence in the literature that supports a need for personalized medicine models and a pragmatic approach to evidence-based opioid use that provides pain relief without adversely affecting patient outcomes.
Although there is evidence that brief exposure to opioids during or after surgery can induce tolerance and hyperalgesia, as well as increased risk of persistent opioid use months later, observational studies have found that interventions such as peripheral nerve blockade are not associated with persistent opioid use after several types of surgery. In terms of chronic pain, opioids present a greater cause for concern due to the increased incidence of addiction. ASRA urges prescribers to choose non-opioid treatments for chronic pain first. When prescribing opioids, they should have a clearly delineated exit strategy to reduce unnecessary risk.
ASRA also urges the use of multimodal analgesia and opioid-free analgesia to reduce the amount of opioids needed for postoperative pain control. In patients with opioid-use disorder, non-opioid analgesics include intravenous infusions such as ketamine and lidocaine as well as neuraxial and peripheral nerve blockade.
"The challenge is to balance the needs of patients in pain against the regulatory burdens, without abandoning patients or ignoring the potential risk of pain medication diversion and abuse," the letter reads.