Helping children and families, patients with pain

May 3, 2022

“When children have pain, it needs to be treated,” said Rita Agarwal, MD, in a recent AMA Advocacy Insights webinar on the stigma facing patients with pain, including young children.

The panel, moderated by Bobby Mukkamala, MD, chair of the AMA Board of Trustees and Substance Use and Pain Care Task Force, also addressed the consequences of untreated pain, the relationship between pain management and health equity, and physician fears when prescribing opioids.

Speakers included: Rita Agarwal, MD, clinical professor of anesthesiology at the Stanford University School of Medicine and past president of the Society for Pediatric Pain Medicine; Edwin C. Chapman, MD, founding member and secretary of the board of directors of the Leadership Council for Healthy Communities; and Cara Sedney, MD, MA, associate professor and residency program director of the West Virginia University Department of Neurosurgery.

Dr. Chapman described the dangers of inaccessible pain medications, saying that “the patients who cannot get access to legal pain medications have no choice and initially move toward street drugs.” With so many of these drugs now being laced with fentanyl, there has been a dramatic rise in overdose deaths related to illicit substances.

Dr. Mukkamala explained this trend, stating that previous policy approaches and the 2016 CDC opioid prescribing guideline focused almost exclusively on how to restrict prescription opioids, increasing the stigma on patients with pain and not addressing the rise in overdose deaths caused by illicit fentanyl, methamphetamine and cocaine. The AMA is pleased the CDC now is proposing to remove the numeric thresholds in the 2016 guideline.

Dr. Sedney’s presentation reinforced this data, focusing on her research into the impact of restrictive opioid prescribing laws on patients. Physicians interviewed as part of the research revealed that fear of disciplinary action led to refusal to prescribe opioids, leaving patients with no choice but to turn to illicit substances.

“Unfortunately, the misapplication of the CDC guideline obstructs much of my ability to assess and treat, and more importantly, it leads to preventable suffering,” said Dr. Mukkamala, citing data from the National Survey on Drug Use and Health (PDF) that many people who say that they misuse opioid analgesics do so to self-treat pain.

“Nearly all of the patients we interviewed in our study who used illicit substances had started with chronic pain, and many of our participants noted that the sort of care gap where they were unable to continue their medication,” said Dr. Sedney, going on to explain the need for fail-safes to prevent patient abandonment and the detrimental impacts of opioid restriction policies on patients with chronic pain.

Dr. Chapman discussed the need to address both physical and psychic pain, especially in Black communities. “We want to take a village approach, and that village approach of course involves medical treatment and reconciliation at the core, but we also need advocacy and legal surveillance,” said Dr. Chapman. He specifically advocated for a better relationship between the criminal justice system and outpatient treatment as a more equitable step toward managing the overdose epidemic.

“Untreated pain has tremendous consequences,” said Dr. Agarwal. Although there are a number of multi-modal or non-opioid approaches to pain treatment that we should continue to explore, she explained, there are insurance barriers that make these alternatives less accessible. “This is why individualized care is so important,” she said.

View the full webinar discussion for more information.

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