The The CDC & Prevention Guideline for Prescribing Opioids for Chronic Pain [pdf] (United States, 2016) is an important publication in the evolution of our nation’s thinking about opioid prescribing. In the mid-1990s we were told to think of pain as the “5th vital sign” because there was perceived to be widespread under-treatment of pain. Educational programs were rolled out encouraging physicians to inquire about and treat pain. These measures were effective; prescribing of opioids increased steadily - at least 4-fold over the first decade of the programs. Tragically, however, the unintended consequence of this policy has been a dramatic increase in opioid addiction and opioid-related deaths. Opioid overdose now kills more Americans than motor vehicle accidents, largely related to prescription opioids.
As surgical specialists, Urologists can play an important role in stemming the overuse of prescription opioids. Opioids prescribed for acute post-surgical pain can, in a significant minority of patients, lead to opioid addiction. Urologists need to be aware of this, and prescribe the lowest dose and number of immediate-release opioids that are required to address the expected pain. Non-opioid regimens should be considered. Additionally, Urologists need to carefully consider altering the pain management regimen in a patient who already is taking opioids regularly for chronic pain or addiction treatment. Finally, there are a few urologic conditions, chronic pelvic pain syndrome for example, where Urologists are called on to be the primarily managers of chronic pain. As such, we need to educate ourselves on the current state of the art with regards to the use and misuse of opioids for chronic pain.
The guideline is full of useful and informative material, but for a quick summary look at Box 1 on page 16.
J. Stuart Wolf, Jr., MD, FACS
Chair, AUA Science & Quality Council