Chronic pain is a debilitating disorder and is both controversial and complex to manage. In the United States, an overreliance on opioids has emerged, largely due to the urgency of patients’ needs and the robust efficacy of opioids for this purpose. According to Volkow and McLellan (2016), about 30% of Americans suffer from chronic or acute pain. In addition, the prevalence of chronic pain is 40% among older adults. Thus, it is unsurprising that opioids are not the most commonly prescribed drugs in the United States. The Centers for Disease Control and Prevention (CDC, 2016) released a report that sought to guide physicians for treating chronic pain. The Guidelines for Prescribing Opioids for Chronic Pain provides the risk and benefits concerning the use of opioids for chronic pain, and to reduce the long-term risk of opioid use.
Volkow et al. (2018) that there are common conditions that cause chronic pain, such as fibromyalgia, neuropathic pain, low back pain, and osteoarthritis. Clearly, the management of chronic pain by opioid administration is a difficult issue.
The three articles to be used in this literature review were mentioned in the introduction. According to Volkow and McLellan (2016), there are two main facts that surround opioid use in chronic pain. Frist, it is that opioids are commonly misused and are diverted. The widespread administration of opioids has resulted in the drug being used on a national epidemic, with many cases of addictions or deaths. For example, more that 44,000 deaths can be traced back to the improper use of opioids. Volkow and McLellan (2016) stated that there was a surge of increase of the rate of opioid addiction, which affected close to 2.5 million Americans in 2014. Secondly, the most common source of opioids were prescriptions, in particular as they relate to chronic
pain. Aside from this, Volkow and McLellan (2016) found that many physicians were not comfortable in prescribing opioids.
On the other hand, Volkow et al. (2018) defined opioid diversion as the transfer or sale of an opioid that is coming from a prescriber that falls into the hands of somebody else rather than the patient who was supposed to receive it. According to Volkow et al. (2018), the most common form of this diversion is the transfer of the drug to another family member to manage generic pain. This is the reason behind Prescription Drug Monitoring Programs. The programs are state-wide electronic databases whose purpose is to collect information on the prescription of drugs that are deemed to be control. This database can also prevent doctor shopping and drug overdose (Volkow et al. 2018).
The CDC (2016) created an algorithm for the use of opioids for managing chronic pain. The CDC (2016) gave guidance for when to initiate or continue opioids for chronic pain; opioid selection, duration of use, dosage, follow-up, and discontinuation; assessing the risk of opioid misuse and addressing harms; and clinical reminders. Overall, the CDC (2016) draws on robust evidence for the use of opioids in patients with chronic pain.
The use of opioids for chronic pain has been supported by numerous studies. The study by Volkow and McLellan (2016) highlights the diversion and abuse of opioids, stating that the analgesic effects of opioid are due to their ability to bind to mu-opioid receptors.
These mu-receptors are densely found in regions of the brain that regulate the perception of pain. In support of this, Volkow et al. (2018) discussed the efficacy of opioid from relieving pain and improving the patients’ functioning. Unlike the CDC report and the report by Volkow and McLellan (2016), Volkow et al. (2018) discussed opioid in greater detail, and the authors differentiated between chronic pain due to cancer and non-cancer chronic pain. All three articles are judged to be credible and each of them has a sound methodology underlying their
conclusions. As an example, Volkow and McLellan (2016) also discusses opioid-induced tolerance as well as signs of physical dependence.These same findings were also found in the CDC report. However, Volkow et al. (2018) relied less on study findings and more on clinical evaluation. The CDC (2016) gave definitive guidelines for the use of opioid. It can be seen that both Volkow et al.(2018) and Volkow and McLellan (2016) were more biased towards clinical studies. The CDC, in addition, was written as more of a guideline, as opposed to the two other studies. Thus, the CDC guidelines were created out of published, peer-reviewed studies.
Chronic pain is a looming problem facing healthcare providers today. The issue of opioid use and abuse has been around for decades. Several organizations, such as the World Health Organization and the CDC have put together algorithms that were meant to address this problem. The three articles included in this paper are all sound- both because of their methodologies and their conclusions. Indeed, it is interested whether the current initiatives against opioid abuse can make a substantial change in this area. Opioid abuse is not only troublesome, but deadly as well.
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