Call to Action – CDC Opioid Guidelines

Interventional pain procedures have a dramatic positive impact on the quality of life of patients allowing them to obtain return of functionality while staying away from opioids medications (or keeping them to a minimum). Specifically, neuromodulation has constantly shown the highest level of evidence in helping patients with difficult to treat painful pathologies.

Neuromodulation is the only procedure that has consistently changed lives, as opposed to merely palliating pain. Forced opioid lowering without expanding access to Neuromodulation, particularly in Medicaid populations, has worsened lives.

As an Inventional Pain Physician and patient myself, I can not stress enough the importance of neuromodulation as the most viable option as an alternative to opioids for severe chronic pain

I have benefitted greatly from non oral opioid therapy treatment for my chronic back pain. I have an intrathecal pain pump which has given me substantial pain relief and increased the quality of life for me and my family.

*The "full spectrum of pain treatment options" should also include rehabilitation, people live in their bodies and do best when they use them well. *I agree the guidelines need to mention interventional and other options, but all of the steps in starting and assessing opioids are reasonable. *The CDC is not responsible for providers who can't read, quoting the guidelines: Established patients … might consider the possibility of opioid dosage reduction to be anxiety-provoking, and tapering opioids can be especially challenging after years on high dosages because of physical and psychological dependence… Clinicians should explain in a nonjudgmental manner to patients already taking high opioid dosages (≥90 MME/day) that there is now an established body of scientific evidence showing that overdose risk is increased at higher opioid dosages. Clinicians should empathically review benefits and risks of continued high-dosage opioid therapy and should offer to work with the patient to taper opioids to safer dosages… Experts noted that patients tapering opioids after taking them for years might require very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages… Clinicians should remain alert to signs of anxiety, depression, and opioid use disorder… that might be unmasked by an opioid taper and arrange for management of these co-morbidities... US Department of Health and Human Services/Centers for Disease Control and Prevention 24 MMWR / March 15, 2016 / Vol. 65 pages 23-24.

Interventional options are an integral part of managing patients pain. Please reconsider and incorporate a multi-modality treatment in your recommendations. You deprive patients of options which in RCT show clear benefit.

Please, reconsider the addition of interventional pain management as part of the CDC recommendations for Pain medicine.

Please reconsider

I have seen many patients lower opioid dose by incorporating interventional pain procedures into the treatment care plan. It need not be an all-or-nothing approach to reducing pain and symptoms and improving function. Addressing conservative therapies, appropriate medications, interventions, and surgical procedures as necessary.

Totally support it.

Interventional pain management and Neuromodulation in particular is an effective treatment option that allows for the decrease in reliance on opioid analgesics.

Interventional pain management procedures are one of the most important tools we have in medicine to divert from utilizing opioid medications.

I strongly urge the CDC guidelines to also include emphasis of buprenorphine and buprenorphine-containing products as an alternative and prior treatment to full-agonist opioids when medication is recommended for treatment of chronic pain. I strongly encourage the CDC to promote this as well to insurance carriers, in order to broaden the availability to all patients, not just the rich who can afford buprenorphine, as pure opioid agonists have historically been cheap by comparison.

Numerous interventional pain management studies confirm that opioid consumption can be reduced, and patient functionality can be increased.

It is a shame that we use the CDC guidelines without using interventional pain management and or neuromodulation as alternatives and adjuncts to medication management. Interventional pain management and neuromodulation or the main stays of a multi modal therapy program design for patients with a greater reliance on diagnosis and treatment algorithms to allow Pain to be managed functionally as opposed to dependency on opioids for long-term care. I think it’s imperative that we use societies such as NANS, ASIPP, ASRA and ISI as partners to allow the CDC guidelines to help decrease reliance on long term opioids and improve functional outcomes.

All for including neuromodulation and IPM procedures in the next round of guidelines!

In order to protect our patient's right to effective and humane policies regarding pain relief, it falls to us as Pain Physicians to stand together and lead the national effort against the opioid epidemic while ensuring that patients are not forgotten.

Guidelines such as these, for 'chronic pain, not otherwise specified' are truly directed at the single largest category of pain patient, those with nociplastic pain. The healthcare system would save enormous amounts of resources and patients would have better outcomes if multidisciplinary, patient-engaged approaches were used, rather than opioids, or even procedures/surgeries for those without clear bodily or neuropathic pain generator in the Cartesian sense. However, for those WITH documented objective disease or neuropathic pain/injury, interventional pain management must be in the treatment paradigm.

I support NANS in regards to have IPM and neuromodulation is a first line alternative to opioids !

any device that alleviates pain is certainly an alternative to "pain" medications, especially opiates