Can stricter prescription drug policies address rising pain levels?

A Delicate Dance Between Pain and Prescription

Ivanka Trump presumably has the president’s ear. So when Massachusetts Governor Charlie Baker found himself seated with her at a National Governors Association dinner Sunday, he took the opportunity to talk about America’s opioid crisis. Baker noted their discussion on CBS This Morning Tuesday.

Can stricter prescription drug policies address rising pain levels?


The Bay State leader explained how his state legislature’s Democrats and Republicans collaborated to develop a 2016 state law that governors of 46 other states now have “signed on to” as a way to address the epidemic in their regions.

The law has “a lot of elements to it,” Baker told the CBS program, “but it’s basically prevention and education on the front end. Better training of prescribers. I mean, until very really recently you could practice medicine, you could be a dentist, you could be a nurse, you could be a physician’s assistant, and never take a course in pain management or opioid therapy. In Massachusetts anyway, you gotta actually take a course and pass it now to graduate from any of those schools.”

Acknowledgment of pain management needs in the midst of public concern about rising use of prescription opioids likely provides some psychological relief to the approximately 100 million Americans who suffer from chronic pain — the constant companion of people with arthritis, some cancers, back damage, migraines and other conditions.

In 2014, more than 28,000 people fatally overdosed on opioids, including heroin. Increases in heroin use are tied to the misuse of and dependence on opioid pain relievers. Nevertheless, the vast majority of prescriptions for opioids reportedly go to people who do not develop addictions, a fact that can get lost in discussions of the current crisis. And policy crackdowns are already having an effect: the proliferation of opioid prescriptions in the U.S. peaked around 2012 and then dropped in 2013, 2014 and 2015.

The need for more effective pain management stands out clearly in a new statistical analysis based on a nationally representative sample of nearly 20,000 adults over the age of 50 who were surveyed repeatedly from 1998 to 2010. At the start of the study, more than a quarter of respondents reported chronic non-cancer pain. But by 2010, that figure rose to more than one third, according to research published in the February issue of the journal Pain.

And while middle-aged people (ages 45 to 64) are the most likely age group to have pain lasting more than 24 hours, a quarter of people between ages 20 and 44 also reported such pain, according to data from the 1999 to 2002 National Health and Nutrition Examination Survey.

In the longitudinal study, levels of pain rose for each age group over time; in other words, new cohorts entering each age group in the study experienced more pain than did the group they replaced for that age interval.

Pain is more than discomfort — it’s a condition unto itself. And higher levels of chronic pain are associated with earlier death on average, the research reveals. Most striking: social disparities in chronic pain apparently mirror social disparities in health care. People of lower socioeconomic means report significantly more pain than people of higher socioeconomic means. Also associated with higher levels of pain: lower levels of education.

“For instance, if you’re just looking at severe pain, someone who doesn’t have a high school degree is 370 percent more likely to have severe pain than someone who has a graduate degree,” says study author Hanna Grol-Prokopczyk, a medical sociologist at the University at Buffalo. “That is really big. That is something that previous studies haven’t shown because they don’t break pain down into mild versus moderate versus severe.”

Unfortunately, some of our federal policy aimed at reducing prescription opioid overdoses and addiction has little to no basis in evidence and may have become so cautious that it forces doctors to either risk professional suicide by prescribing, or deny pain medications to patients who need them, two physicians wrote last week in the online publication STAT.

A draft policy released last month by the Centers for Medicare and Medicaid Services ratchets down the dosage threshold at which pharmacies can be blocked from dispensing opioid painkillers. This limit could provoke withdrawal and dysfunction among people currently on higher doses for pain relief.

Many research questions surround who suffers from differing pain levels, why they do, how they are treated and the implications for overall health. For instance, Grol-Prokopczyk was surprised to find in her analysis that pain levels among Americans over 50 actually went up as opioid analgesics use rose in the first decade of the 21st century.

“There’s growing evidence that when used in long-term, opioids can increase pain,” she says. “It’s possible that the pain profile of the country was made worse by the widespread use of opioids.”

Clearly, little of what is known about pain and public health inspires confidence in new policy directions regarding prescription opioids. But educating the president’s adult daughter about policies already making a difference was more constructive than demonizing people in need of medical attention.