Focused research to enable safer and more effective use of opioids

Over the past year, the Michael G DeGroote Institute for Pain Research and Care has offered a series of articles in Open Access Government about issues surrounding the opioid crisis, with a focus on events and practices in Canada, but what else is there to know?

This series highlighted several areas where significant information gaps create challenges for the development of evidence-based guidelines for the use of opioids for chronic pain

These informative pieces explored the many facets of opioid use in Canada, such as the effectiveness of risk mitigation strategies (e.g., treatment agreements, co-prescription of naloxone, urine drug screening, monitoring of prescription drug plan databases), the impact of opioid tapering on the risk of overdose, and optimal approaches to facilitating opioid tapering among patients who voluntarily agree to reduce their dose.

Managing chronic pain without opioids

Other research has raised questions about the development of chronic pain after injuries or surgery, and the potential role of suppression of the inflammatory healing process by non-opioid analgesics – especially with potent anti-inflammatory agents. Clinical protocols are being developed for perioperative analgesic care to reduce use of opioids, in order to reduce opioid dependence; however, care is warranted to ensure that such practices do not increase the prevalence of persistent post-surgical pain.

These issues highlight the need for specific studies and independent funding sources directed at answering these questions. These knowledge gaps are unlikely to be addressed in the normal course of new drug development, a field which tends to support much pharmacological research.

Chronic pain and supporting its research

As a complex bio-psycho-social phenomenon, chronic pain requires the integration of medical and non-medical care in a way that has no specific industry sponsor, and therefore, several important areas of study require non-industry funding.

Issues such as the interaction between mental health disorders and analgesic needs, the impact of exposure to opioid analgesia on patients with a history of substance use/abuse, and the optimal balance of pharmacological, physical and psychological care – are all important issues in pain care that require evidence to support clinical guidelines and policy decisions.

Future pieces from the team will discuss how to ensure this is accomplished and the search for models of research funding that support this.