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AAPM Comments on NIH Report on National Efforts to Address the Opioid Crisis

Comments from the American Academy of Pain Medicine 

The American Academy of Pain Medicine appreciates the opportunity to provide comments regarding the Roadmap and of the federal action to address not only the national opioid crisis but also the challenges in treatment of pain that are one contributing factor to the crisis. 

From an overall perspective, the Roadmap is an appropriate response to the national situation. It is comprehensive and well-balanced and addresses most areas in which intervention is needed and likely to be beneficial. We have a few comments for areas of improvement, which in no way diminish our approval of the work that was done to prepare the strategies detailed. 

  • Section 3 (Pain Management) could better highlight the demonstrated effectiveness of, and limited access to, behavioral medicine strategies in inpatient and especially perioperative pain management. This is important not only for reduction of suffering and surgical complications but also presents a unique opportunity to limit opioid exposure to vulnerable populations. There remains a gap in scientific knowledge of the neuroendocrine and immunological effects of long-term opioid therapy. Study of these issues is especially important given the widespread prevalence of the treatment. Additionally, there is an unmet need for study of the impact of neuromodulation on both pain and substance use disorder. 
  • Section 5 (Treatment of Opioid Addiction and Withdrawal) should call for research on the impact of abrupt withdrawal on patient health and subsequent behaviors, to better delineate the risks of such actions. Additionally, it should call for research on the relative risks of involuntary dose tapering vs continuing provision of doses or combinations deemed harmful, high-risk or ineffective. 
  • Section 8 (Opportunities for Enhanced Coordination) notes the need for dissemination of information and education to the public and to health care providers; however, it does not adequately address the failure of healthcare education to prepare providers to properly manage acute and chronic pain. This represents a grossly inadequate response to what is widely recognized as an epidemic of pain, and characterizes both graduate as well as post-graduate training.

About AAPM
The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 35th year of service, the Academy's mission is to advance and promote the full spectrum of multidisciplinary pain care, education, advocacy, and research to improve function and quality of life for people in pain. Information is available on the Academy's website at painmed.org. 

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