Dr. Anna Lembke
On June 9, 2015, the Patient-Centered Outcomes Research Institute (PCORI) hosted a stakeholder workshop to prioritize comparative effectiveness research (CER) questions for long-term use of opioids for chronic pain. ASAM was invited to participate, and Dr. Anna Lembke, Assistant Professor of Psychiatry and Behavioral Sciences (Public Mental Health and Population Sciences) at the Stanford University Medical Center, represented ASAM at the workshop.
Recent work by the National Institutes of Health (NIH) and Agency for Healthcare Research and Quality (AHRQ) motivated the meeting. In September, 2014, NIH held a Pathways to Prevention Workshop which examined the role of opioids in the treatment of chronic pain. Workshop participants concluded that individualized, patient-centered care is needed to treat and monitor the estimated 100 million Americans living with chronic pain. They recommended more research and development around the evidence-based, multidisciplinary approaches needed to balance patient perspectives, desired outcomes and safety.
Also in September, AHRQ published the results of a systematic review on the benefits and harms of opioid therapy for chronic pain. Results from the systematic review suggest that additional research is needed that focuses on the following:
- Opioid dosing strategies;
- Opioid assessment and risk mitigation tools;
- Long-term opioid treatment in high risk patients; and
- Alternatives to opioid use as long-term strategies for pain relief.
As a next step to inform this research, participants at the day-long PCORI workshop this June prioritized a set of research questions. They discussed CER questions focusing on pharmacologic treatment options and dosing strategies as well as CER questions around non-pharmacologic options, risk assessment/risk mitigation strategies and opioid dependency.
“The meeting was very productive,” said Dr. Lembke. “We spent the day narrowing scores of research questions down to just four. The number one question that emerged is how to treat patients with co-occurring pain and addiction.”
The research questions identified by the workshop participants will now go to the PCORI Board of Governors for consideration and a potential funding announcement.
For those seeking immediate training on managing risks when using extended release and long acting opioid analgesics, ASAM offers a free course to clinicians. More information is available on the course website.