Daniel Clauw, MD: Impact of Public Perception on Pain Management

As clinicians and policy makers continue to move forward in the midst of the opioid epidemic, often times there appears to be a disconnect between thought leaders in each space.

While they find common ground on the risk that accompanies opioid use disorder and the addictive potential opioids, there are patients for some conditions where long-term opioid use for chronic pain is one of the only viable options for a patient.

As a result of heightened awareness surrounding the issue, clinicians have seen progress and regression in certain areas. In the past, opioids may have been a first line therapy for some with pain, but studies have shown clinicians are less likely to start new patients on opioids then they had been previously.

Yet, even with the best intentions behind them, policy and public stigma surrounding opioids can have a negative impact on patients who have a medical need for opioids. As a result, some patients without opioid use disorder have been taken off opioids, which they need for chronic pain.

For more on how the public perception of opioids has impacted pain management in rheumatology, MD Magazine® sat down with Daniel Clauw, MD, professor of medicine and director of the Chronic Pain and Fatigue Research Center at the University of Michigan, to get his take on the topic.

MD Mag: How has public perception impacted chronic pain management for patients with rheumatic disorders?

Clauw: So there's been a lot of press about opioids and that and other things have caused either state governments, city governments, countries, or health systems to pass laws, suggesting that people should be tapered off of their opioids very rapidly or in some cases, those laws either suggest or imply that people should be abruptly stopped on their opioids and that has had some fairly catastrophic consequences. In some individuals, it's led to suicide attempts. In some individuals, they then up getting their opioids down the street and then end up, using heroin instead of a prescription opioid, which puts them at risk of dying of an opioid overdose—if that heroin has happens to be laced with fentanyl or carfentanyl.

So, I think we should de-associate these two things. I think it's appropriate for healthcare providers to look at what's happened with opioids and say, "I don't think it's a good idea to newly start my chronic pain patients on opioids,", And if every healthcare provider in the United States and beyond had that attitude—that would just be good. Where the bad comes in is how they handle the people that are already on opioids, because those people have to be handled very gently. Again, most of these people are dependent upon these drugs, you can't just rapidly taper the drugs. A smaller portion of them actually benefits from them with better pain control.

I think that in the people that are already on opioids, we have to take a very sort of cautious and careful approach. Most of those people should slowly gradually taper their opioids to make sure that the opioids are of some benefit to them, but we shouldn't be—in any way—dramatically cutting these people off, because it is in fact quite dangerous.