In 2016, the Centers for Disease Control and Prevention (CDC) issued the Guideline for Prescribing Opioids for Chronic Pain, a resource for primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
Included in the 2016 guideline was the stated intent to reevaluate the guideline as new evidence became available and to determine when sufficient new evidence might prompt an update. The public comment period ended April 11 and a new guideline is expected to be released by the end of 2022
Since the guideline was released in 2016, the abuse of opioids, including prescription opioids, has grown and increasingly been labeled not only an epidemic, but a crisis. According to National Center for Health Statistics data, between 1999 and 2019 nearly 247,000 people died in the United States from overdoses involving prescription opioids. Overdose deaths involving prescription opioids more than quadrupled in that 20-year period.
These issues have presented significant challenges for physicians and other health care providers as they seek to manage pain for patients and give the best quality of care.
Matthew Iorio, MD, associate professor of plastic and reconstructive surgery in the University of Colorado (CU) Department of Surgery, has conducted significant research on opioid reduction strategies and therapies for chronic phantom and extremity pain.
His research on the use of peripheral nerve catheters (PNC) during microvascular limb salvage surgery found that among study participants, PNC use for lower extremity free flap transfer significantly reduced concurrent narcotic use and shortened length of hospital stay. His research showed similar results using local anesthetic options for breast reconstruction surgery.
Further research found evidence that targeted muscle reinnervation (TMR) therapies led to near-total resolution of neuroma pain in treating phantom limb syndrome following extremity amputation.
We recently spoke with Iorio about the challenges of pain management in light of the ongoing opioid crisis and the CDC’s call for public comment in revising the prescribing guidelines.