European Pain Federation position paper on appropriate opioid use in chronic pain management

Abstract

Poorly controlled pain is a global public health issue. The personal, familial and societal costs are immeasurable. Only a minority of European patients have access to a comprehensive specialist pain clinic. More commonly the responsibility for chronic pain management and initiating opioid therapy rests with the primary care physician and other non‐specialist opioid prescribers. There is much confusing and conflicting information available to non‐specialist prescribers regarding opioid therapy and a great deal of unjustified fear is generated. Opioid therapy should only be initiated by competent clinicians as part of a multi‐faceted treatment programme in circumstances where more simple measures have failed. Throughout, all patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to yield the desired results and/or the patient is additionally burdened by an unacceptable level of adverse effects, the overall management strategy must be reviewed and revised. No responsible clinician will wish to pursue a failed treatment strategy or persist with an ineffective and burdensome treatment. In a considered attempt to empower and inform non‐specialist opioid prescribers, EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper on appropriate opioid use in chronic pain. The expert panel reviewed the available literature and harnessed the experience of many years of clinical practice to produce these series of recommendations. Its success will be judged on the extent to which it contributes to an improved pain management experience for chronic pain patients across Europe. Significance This position paper provides expert recommendations for primary care physicians and other non‐ specialist healthcare professionals in Europe, particularly those who do not have ready access to specialists in pain medicine, on the safe and appropriate use of opioid medications as part of a multi‐faceted approach to pain management, in properly selected and supervised patients.

Decline in opioid prescribing after federal rescheduling of hydrocodone products

“…Actively treated cancer patients had substantially larger absolute reductions and similar relative reductions in the rate of HCP prescribing compared with non‐cancer patients . Several studies have raised concerns about the potential for unintended consequences of the federal policy on the adequacy of pain treatment in cancer patients undergoing chemotherapy and other cancer‐specific interventions …”

Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016

“…It has been estimated that about 20% of the adult population in Europe suffer from moderate to severe chronic pain, requiring considerable medical and social costs. Besides non‐steroidal‐antiinflammatory drugs and weak opioids (such as codeine) used to treat light to moderate pain, strong opioids (i.e., morphine‐like analgesics) have been introduced since the early 1980s to treat severe pain, particularly in cancer patients (Caraceni et al., ; Corli et al., ; O'Brien et al., ; World Health Organization , ).…”

Chronic pain management and the development of opioid use disorder

“…8 In 2013, the European Pain Federation (EFIC) found that 82% of medical schools across 15 European countries did not have mandatory pain management education for undergraduate students. 9 To address this, the EFIC published the Pain Management Core Curriculum for European Medical Schools and now offers a Diploma of Pain Management. 9 We, therefore, suggest that Canadian medical schools respond to current inadequacies in undergraduate medical education by expanding upon current core curricula in pain management, while simultaneously instituting policies that will ensure proper dissemination and mandatory implementation nationwide.…”

“…9,10 Proven to be a cost effective educational method, academic detailing involves synthesis and propagation of up-to-date clinical knowledge through one-on-one educational sessions with practicing physicians. 10 In 2010 and 2013, respectively, the Dalhousie and BC Provincial Academic Detailing Services developed courses on opioid use in chronic non-cancer pain.…”

“…Canadian medical institutions may wish to call upon European educational strategies when developing the pain curricula and implement policies to ensure ubiquity. 9 Additionally, use of academic detailing for CME should be augmented and funds should be allocated for opioid related material development. [10][11][12] To comprehensively address opioid abuse disorder, changes to clinical practice, public health policies, and funding allocation are surely required.…”