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Redefining Chronic Pain with the ‘Nopioid’ Approach

September 20, 2023 from Medscape


In the ever-evolving realm of pain management, the role of opioids has been a subject of intense discussion and scrutiny. Medscape recently published an interview with Dr. Daniel Clauw, a distinguished professor at the University of Michigan in Ann Arbor. Dr. Clauw is currently leading a groundbreaking clinical trial on treatments for chronic back pain, and his insights are instrumental in shaping the future of pain management.


Dr. Clauw’s perspective on opioids for chronic pain is clear: they should be used sparingly, if at all. He expresses concerns about the lack of a stronger anti-opioid stance within the field of pain management.


One of the key takeaways from the interview is the importance of comprehensive studies comparing opioid and non-opioid treatments for chronic pain. Dr. Clauw references the Krebs study and a more recent study, both of which revealed a significant finding: opioid-treated patients had statistically worse pain scores than non-opioid-treated patients after a year.


According to Dr. Clauw “what people failed to note in both of those studies is that the group of people that received the opioids didn’t just not do better than the non-opioid people, they did worse.”


He counters the argument that opioids are prescribed to patients with more severe pain, suggesting that opioids may actually exacerbate discomfort for some individuals with chronic pain. Therefore, he recommends considering opioids as a last-resort option when all other treatments have been exhausted.


“I really do think we should be putting opioids where they were 25 years ago: You use them only when nothing else has worked.” stated Clauw.


The interview also highlights the high all-cause mortality associated with opioid use, which extends beyond overdose deaths. Dr. Clauw points out that opioid use significantly increases the risk of myocardial infarctions, motor traffic accidents, suicides, and other life-threatening conditions.


Dr. Clauw indicated that “it’s not because of overdose deaths, but it’s due to higher rates of myocardial infarctions, motor traffic accidents, suicides, and many other things that people die of at very high rates when they’re taking an opioid.”


Dr. Pathak, who conducted the interview, acknowledges the challenges in pain management, including regulatory hurdles, patient expectations, and the potential adversarial relationships that can develop due to pain contracts or agreements.


Pathak included that “it leads to difficulty in that physician-patient relationship.”


Dr. Daniel Clauw’s insights challenge conventional approaches to opioid use in chronic pain management. He emphasizes the need for a cautious and evidence-based approach, advocating for opioids as a last-resort option. As the field of pain management evolves, Dr. Clauw’s perspective encourages healthcare professionals to prioritize patient well-being and safety, ultimately reshaping the way we manage chronic pain in a post-opioid era.





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