Chronic Pain Experience Map, Record Deaths Tell Story of Opioids in the US

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published a Chronic Pain Experience Journey Map as part of the Department of Health and Human Services’ (HHS) Overdose Prevention Strategy. The visual is intended to highlight significant barriers to care for those experiencing chronic pain, such as insufficient insurance coverage, no primary care provider, or other access challenges, and to shine light on the various influences on providers as they treat chronic pain patients.

This work integrates input from various stakeholders, including the American Society of Anesthesiologists (ASA), following requests for information conducted by CMS and the Center for Disease Control and Prevention (CDC). The CDC particularly has sought to understand and integrate the lived experiences of patients and providers into their update to the 2016 opioid prescribing guideline.

Updated Clinical Practice Guideline for Prescribing Opioids

The CDC released the draft updated Clinical Practice Guideline for Prescribing Opioids back in February, and the 60-day comment period closed on April 11, 2022. The revised document updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, providing evidence-based recommendations for clinicians who provide pain care, including those prescribing opioids, for outpatients age 18 years and older with acute pain, subacute pain, or chronic pain, not including sickle cell disease related pain management, cancer pain treatment, palliative care, and end-of life care.

The draft proposal includes recommendations for primary care clinicians, outpatient clinicians managing dental and postsurgical pain, emergency clinicians providing pain management for patients being discharged from emergency departments, and outpatient clinicians in other specialties. The recommendations cover four categories:

Determining Whether or Not to Initiate Opioids for Pain
Opioid Selection and Dosage
Opioid Duration and Follow-Up
Assessing Risk and Addressing Harms of Opioid Use

Ongoing Opioid Crisis

New provisional data released by the CDC last week shows that more than 107,000 Americans died from drug overdoses in 2021–a new record high for the US and up nearly 50 percent over the past two years. Deaths from opioids also increased, from 70,029 in 2020 to 80,816 in 2021.

Even so, opioid prescriptions have declined in recent years. Earlier data from the CDC shows that opioid prescriptions peaked in 2012, at a rate of 81.3 prescriptions for every 100 people, but declined to a rate of 43.3 prescriptions for every 100 people in 2020, the latest year of data.

That change is attributed, in part, to overly rigid interpretations of the 2016 CDC opioid prescribing guideline, which left fewer treatment options for patients with chronic pain, denials of coverage for long-term opioid prescriptions, and even some physicians being investigated for improper prescribing, according to Stefan Kertesz, MD, a professor and opioid policy researcher at the Marnix E. Heersink School of Medicine at the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center. Those barriers are reflected in the Chronic Pain Experience Journey Map.

In the updated guideline, the CDC has emphasized that the “recommendations are voluntary and are not intended to be applied as inflexible standards of care or replace clinical judgment or individualized, patient-centered care.” Still, according to David Dickerson, MD, chair of the ASA Committee on Pain Medicine, the guidelines “exclude populations such as patients who are hospitalized or in acute care settings, such as emergency departments, and in the care of patients with sickle cell disease or receiving end-of-life care” and also “fail to describe the current state of the art for pain care in those domains, omitting much of the evidence-based treatments commonly employed.”

According to the CDC, release of a final updated Guideline is anticipated in late 2022, along with a suite of translation and communication resources to facilitate effective implementation.

Using the Chronic Pain Experience Journey Map

Meanwhile, in a statement regarding the release of the Chronic Pain Experience Journey Map, the ASA said they are “pleased CMS is prioritizing various perspectives on experiences with pain and pain management and applauds the efforts to understand more about access to covered care and services for people with chronic pain.”

The Great Plains Quality Innovation Network (GPQIN) also is encouraging clinicians to use the map to help “explore where opportunities exist outside of the parameters of government to bring ease for those suffering with chronic pain, such as eliminating the stigmas that exist not only for those who suffer with chronic pain, but also those who suffer with behavioral health issues as well as those who suffer from opioid use disorder.”

GPQIN also offered the following “important reminders on ways to reduce chronic pain”:

Avoid Smoking
Create a daily schedule that includes a few priorities and time for rest and self-care
Exercise regularly
Manage your stress
Eat a healthy diet
Limit alcohol, which can cause problems with sleep and pain
Join a support group for chronic pain to learn from other people with similar conditions

Learn More

Check out the following resources to learn more about the CDC’s Chronic Pain Experience Journey Map and the the CDC’s updated Clinical Practice Guideline for Prescribing Opioids.