ABSTRACT
The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patient-centered, multi-modal treatment plans.
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Acknowledgments
Dr. Becker was supported by a Veterans Health Administration Health Services Research & Development Career Development Award (08-276); Dr. Fraenkel was supported by NIAMS K24 AR060231-01; Dr. Kerns was supported by VA Health Services Research and Development Research Enhancement Award Program (REA 08-266); Dr. Fiellin was supported by NIDA R01-DA020576-01A1 and NIAAA U01-AA020795-01.
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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
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The authors declare that they do not have a conflict of interest.
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Becker, W.C., Fraenkel, L., Kerns, R.D. et al. A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care. J GEN INTERN MED 28, 1364–1367 (2013). https://doi.org/10.1007/s11606-013-2422-4
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DOI: https://doi.org/10.1007/s11606-013-2422-4