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Opioid analgesics have a place in therapy; knowing when and how to use is key

Optum Workers' Comp
| Jul 11, 2017

The recent agreement between the U.S. Food and Drug Administration (FDA) and Endo Pharmaceuticals to have Opana® ER removed from the U.S. market highlights the ongoing need for awareness on the safety of opioid analgesics and a better understanding of how the medication can affect the major body systems. While this decision resulted from research determining the benefits of using reformulated Opana ER no longer outweigh its risks, the question of whether or not opioid analgesics should continue to have a place in medication therapy remains.

In our experience, a time and place for opioid analgesics exist in the treatment of injury-related pain. For post-surgical pain and acute injuries, such as fractures and crush injuries, the initial pain may not be controllable with non-opioid analgesics. It is during this early phase of the injury that short-acting opioid analgesics, such as hydrocodone and oxycodone, may be medically necessary and should be an available treatment option, if appropriate for the claimant and in accordance with prescribing and/or treatment guidelines. However, it is also during this timeframe, after the acute pain intensity decreases, that the plan for ongoing pain management should be developed and discussed with the claimant. When doing so, a straightforward approach is often the most effective. For instance, the prescriber may state the following… “this (opioid) medication will help control your pain over the next several days but it is not intended to be used on a long-term basis for this type of injury. Over the next couple of days, the amount of this medication being taken should be decreased and I am going to provide you with instructions on how to do this. At the same time, it is important to bring your pain under sufficient control while keeping you moving and active as your body starts to heal.”

Based on the individual claimant’s injury and specific circumstances, an expected date for discontinuing opioid analgesics should also be established before the first opioid prescription is filled. Furthermore, as with all medical treatments (pharmacologic and nonpharmacologic), the benefits of treatment need to outweigh the risks and the claimant should demonstrate understanding of those benefits and risks. While situations and complications may arise requiring a longer duration of pain management, additional non-opioid analgesic treatment measures should be incorporated, such as adjuvant pain medications, psychological evaluation and physical medicine treatments.

Opioid analgesics are not generally recommended for the ongoing (chronic) treatment of injury-related pain as they are often associated with increasing side effects, tolerance, drug-drug interactions, as well as the potential for abuse, misuse and addiction. However, for those claimants with chronic pain who are demonstrating a safe and compliant use of their opioid analgesic medications, along with well-documented and objective improvements in their level of function, the ongoing use of opioid analgesics at the minimally required dosage may not be, by itself, inappropriate. In fact, the early discontinuation of opioid analgesics in claimants with genuine pain symptoms can place some claimants at increased risks from the excessive use of other non-opioid analgesics, such acetaminophen and nonsteroidal anti-inflammatories. Therefore, a holistic view of the claimant’s current condition and risks to help make better decisions for their continued pain control and quality of life is essential.

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