Call to re-educate patients, doctors about limits of opioids for chronic pain

Patients and their doctors need to be re-educated that opioids such as codeine are not effective for the long-term treatment of chronic pain because unrealistic expectations are fuelling the explosion in prescription opioid abuse, according to one of Australia and New Zealand’s leading pain medicine specialists.

Professor Stephan Schug, the Director of Pain Medicine at Royal Perth Hospital and Chair of Anaesthesiology at the University of Western Australia’s medical school said it was time that the community recognised that “passive” treatment for chronic pain by the continued prescribing of opioids did not work.
 
“We need to educate patients and doctors that opioids are not useful for chronic pain because we are prescribing totally inappropriate amounts (of opioids) for pain control which are not effective, often harmful and lead to problems such as abuse or diversion,” he said.
 
Professor Schug is presenting a paper, “The patient with an addiction”, at a meeting of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (ANZCA) in Torquay, Victoria on Saturday September 23.
 
“Many people have totally unrealistic expectations of how to treat chronic pain so they might say ‘Doctors can transplant hearts and kidneys so why can’t you fix my back pain?’”
 
“Chronic back pain is not a disease with a medical solution – it is best managed with education, exercise and improved coping skills. However, many patients expect a ‘quick fix’ with medication, get opioids prescribed and we now know that doesn’t work.”
 
In the US, where President Donald Trump recently declared the opioid crisis a national emergency, an interim report by the Commission on Combating Drug Addiction and the Opioid Crisis recommended medical education training for doctors who prescribe opioids among a raft of measures to combat the epidemic.
 
“It would be wrong to say Australia has no opioid prescribing epidemic. I think it has one,” Professor Schug said.
 
Professor Schug said there had been a dramatic increase in prescription opioid use in Australia and New Zealand over the last decade. He welcomed recent federal and state government moves to introduce real-time prescription monitoring systems to help address this.
 
“In Melbourne for example over the last 10 years the consumption of oxycodone for pain relief has increased 80-fold. In most western countries we have more deaths from prescription overuse than from heroin abuse. Heroin has to a large extent been replaced by people who take drugs which are intended for medical use and this is the new epidemic.”
 
Professor Schug said one of the consequences of the opioid epidemic was that chronic pain clinics increasingly needed to employ drug addiction specialists as part of their staff teams.
 
“I work currently in two chronic pain clinics. Out of eight patients I would see in a morning, six are having problems with inappropriate opioids and suffer the consequences. We’re now getting drug abuse specialists joining our multi-disciplinary team for the first time to help us manage patients that are so complex because of opioid use.
 
“What this shows is that many of our primary healthcare providers have insufficient training in chronic pain as a socio psycho-biomedical issue – they focus purely on the biomedical approach instead of getting patients into self-management programs, with treatment such as physiotherapy and exercise. These are much more useful as treatment for chronic pain in many cases than simply prescribing an opioid,” Professor Schug said.
 
“We are now starting this re-education process and it’s important that we deliver this message to GPs to promote better chronic pain management and avoidance of opioids.”
Professor Schug said the medical profession “has more or less created this image of we can repair anything.”
 
“It’s a bit like a car repair shop ─ you bring your back pain into a repair shop, someone gives you a drug or injection and you walk out pain free.”
 
Professor Schug said most hospitals in Australia and New Zealand had noticed a shift in the type of patients presenting in emergency hospital departments over the last decade.
 
“The number of patients addicted to opioids and with acute pain problems continues to increase and they require surgical interventions for accidents occurring under the influence of drugs and complications of their drug abuse such as abscesses, embolisms and even amputation in some cases.’’
 
About FPM
 
The Faculty of Pain Medicine is a world-leading professional organisation for pain specialists that sets standards in pain medicine and is responsible for education and training in the discipline in Australia and New Zealand. Pain medicine is multidisciplinary, recognising that the management of severe pain requires the skills of more than one area of medicine.
 
Chronic pain affects about one in five people in Australia and New Zealand. Specialists also manage acute pain (post-operative, post-trauma, acute episodes of pain in medical conditions) and cancer pain. 
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