Emerging Technologies in Chronic Pain Pharmacotherapies
Bruce R. Canaday, PharmD, FASHP, FAPhA*
An estimated 9 in 10 Americans regularly suffer from pain, while approximately 33% will experience chronic pain at some point in their lives. In addition, at any given time approximately 9% of the US adult population is experiencing moderate-to-severe non–cancer-related chronic pain. Pain is also the most common reason individuals seek healthcare.
Yet the management of chronic pain remains substandard, with only 20% to 50% of all chronic pain sufferers saying their pain is not well controlled. Even among those whose pain is controlled, it can take months or even years to reach that goal.
Part of the reason for undertreatment of chronic pain is the concern over abuse and misuse of the opioids that are often used to treat this condition. Prescription drug abuse, particularly of opioids and particularly in adolescents and young adults, is a significant problem in the United States. In 2003, an estimated 13.7 million individuals abused oxycodone, a 13% increase over the previous year.
Concern about addiction presents another challenge to adequate pain management, despite studies showing a relatively small risk of addiction to opioids and that this risk is primarily in those with a history of substance abuse.
Clinicians face the challenge of maintaining a balance between preventing the abuse, diversion, and "morbidity" linked to the illicit use of opioids and providing adequate pain relief. In addition, they also must not 'stigmatize' patients with chronic pain, but work to understand the underlying cause of their pain to provide the most appropriate treatment.
This issue of University of Tennessee Advanced Studies in Pharmacy includes summaries of presentations from a symposium held in conjunction with AMCP's 21st Annual Meeting & Showcase, on April 16, 2009, in Orlando, Florida. Lynn Webster, MD, FACPM, FASAM, medical director of Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah, discussed the challenge of opioid misuse, addiction, diversion, and abuse, as well as novel opioid formulations that are now in clinical trials and their potential to reduce the risk of abuse and misuse. John P. Barbuto, MD, PC, medical director of Neurology-in-Focus, HealthSouth Rehabilitation Hospital in Sandy, Utah, outlined the current state of pain management, particularly issues in chronic pain undertreatment. He urges clinicians to focus on the individual patient and the underlying cause of the pain — whether physical or emotional — in order to provide the most appropriate treatment. Bruce R. Canaday, PharmD, FASHP, FAPhA, director of the Department of Pharmacotherapy at the South East Area Health Education Center in Wilmington, North Carolina, and vice-chair in the Division of Pharmacy Practice and Experiential Education at the University of North Carolina in Chapel Hill, discussed chronic pain perspectives for the managed care pharmacist. He raised numerous issues about the potential for novel opioid formulations to reduce abuse and about their potential effect on the patient/clinician relationship, as well as their anticipated cost. This issue concludes with a question and answer session that includes the faculty's collaborative responses to questions from the audience.
After completing this monograph, readers will have an enhanced understanding of current barriers associated with optimal opioid therapy and methods to overcome those barriers, approaches to improve their management of patient symptoms and patient quality of life, and emerging treatment options related to abuse-resistant technologies.
*Director, Department of Pharmacotherapy, South East Area Health Education Center, Wilmington, North Carolina; Vice-Chair, Division of Pharmacy Practice and Experiential Education, University of North Carolina, Chapel Hill, North Carolina.
Address correspondence to: Bruce R. Canaday, PharmD, FASHP, FAPhA, Director, Department of Pharmacotherapy, South East Area Health Education Center, PO Box 9025, 2131 South 17th Street, Wilmington, NC 28402. E-mail: firstname.lastname@example.org.