BETHESDA, MD. – The reimbursement model for managing patients with chronic pain needs to change before physicians will stop prescribing opioids, according to Dr. Daniel J. Clauw, speaking at a National Institutes of Health–sponsored pathways to prevention panel on opioids. Certain types of chronic pain that are most common in young adults are the least likely to respond to opioids. These include headache, fibromyalgia, irritable bowel syndrome, peripheral nerve damage, temporal mandibular joint pain, and interstitial cystitis. Opioids may make them worse. Unfortunately, physicians are not reimbursed to provide the types of therapy that are effective at lessening the discomfort of patients with these chronic pain conditions, such as exercise and/or cognitive-behavioral therapy, said Dr. Clauw, who is professor of anesthesiology, medicine (rheumatology), and psychiatry at the University of Michigan in Ann Arbor. He serves as director of the Chronic Pain and Fatigue Research Center there.
In interviews at the meeting, Dr. Clauw discussed the major types of chronic pain and addressed the lack of data supporting use of opioids in almost all chronic pain conditions.