Background: The management of chronic nonmalignant pain with high-dose opioids has
partially contributed to the current opioid epidemic, with some responsibility shared by chronic
pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as
a source for continued medical management of patients on high-dose opioids, often resulting
in tolerance and escalating doses. Although opioids continue to be an important component of
the management of some chronic pain conditions, improvement in function and comfort must
be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain
and function with the use of a multimodal approach to pain management. We assessed whether
the application of multimodal treatment directed by pain specialists in a pain clinic provides for
improved function and reduced dosages of opioid analgesics.
Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in
reducing pain and opioid use in chronic nonmalignant pain patients.
Study Design: This study used a retrospective design.
Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching
hospital.
Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first
evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy
and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up
visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and
various functional parameters.
Results: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain
frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively.
Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use
decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day.
Limitation: This study is not a randomized prospective controlled study. The patients analyzed
are still getting therapy and their pain status may change. Some opioids are underrepresented in
the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender,
and duration of opioid use.
Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving
pain and function in patients on chronic opioids. We wish to emphasize the importance of
allocating resources toward nonopioid treatments that may improve the function and well-being
of patients.
Key words: Pain clinic, pain management, multimodal pain management, chronic pain, opioid
reduction, improved pain, improved functional capacity
Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards
