Opioids are an established and effective tool in the armamentarium of pain relief strategies for the management of complex, acute, and/or persistent pain in select disease-specific patient populations. However, in recent years the escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. In the management of cancer and sickle cell disease, multiple reports indicate that a patchwork of regulatory and coverage policies, intended to curb inappropriate opioid use, has led to significant barriers for many cancer patients when opioid use is clinically indicated for pain management.1,2
Pain management is complex and multifactorial. Clinical practice guidelines from leading organizations play a crucial role in informing appropriate opioid prescribing practices for patients in general and for select groups with unique pain management needs. A recent JAMA Oncology article3 highlighted perceived variability in the scope and recommendations among commonly used clinical practice guidelines for cancer-related pain. The article referenced guidelines from the Centers for Disease Control and Prevention (CDC),4 NCCN,5,6 and ASCO.7 The authors of that article contend that variability in clinical practice guidelines may lead to confusion among primary care, oncology, and other prescribers, and highlight the need for collaboration among guideline developers to resolve inconsistencies in guideline recommendations. In response to these concerns, NCCN and ASCO convened a meeting to address perceived variance among clinical practice guidelines for pain management in patients with cancer or sickle cell disease.6
In November 2018, NCCN and ASCO held a meeting entitled “Bridging the Critical Divide Among Clinical Practice Guidelines for Cancer Pain and Sickle Cell Disease.” Featured attendees included representatives from NCCN, ASCO, the American Society of Hematology (ASH), the CDC, the FDA, and the authors of the JAMA Oncology article. This article outlines the discussion and conclusions from this meeting, including possible next steps identified by participants to ensure access to appropriate pain management tools while also minimizing the risk of opioid use disorder for patients with cancer or sickle cell disease.8
Page R, Blanchard E. Opioids and cancer pain: patients’ needs and access challenges. J Oncol Pract 2019;15:229–231.
Sinha CB, Bakshi N, Ross D, et al.. Management of chronic pain in adults living with sickle cell disease in the era of the opioid epidemic: a qualitative study. JAMA Netw Open 2019;2:e194410.
Meghani SH, Vapiwala N. Bridging the critical divide in pain management guidelines from the CDC, NCCN, and ASCO for cancer survivors. JAMA Oncol 2018;4:1323–1324.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. MMWR Recomm Rep 2016;65:1–49.
Paice JA, Portenoy R, Lacchetti C, et al.. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2016;34:3325–3345.
Darbari D. Presentation at the Bridging the Critical Divide Among Clinical Practice Guidelines for Cancer Pain and Sickle Cell Disease meeting; November 8th, 2018; Washington, DC.
Guyatt GH, Oxman AD, Vist GE, et al.. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–926.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. JAMA 2016;315:1624–1645.
National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease. Expert panel report, Accessed February 25, 2019. Available at: http://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report.pdf
National Council of State Legislatures. Prescribing policies: States confront opioid overdose epidemic. Table: State prescribing legislation. Accessed August 18, 2019. Available at: http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx
Lin DH, Jones CM, Compton WM, et al.. Prescription drug coverage for treatment of low back pain among US Medicaid, Medicare Advantage, and commercial insurers. JAMA Netw Open 2018;1:e180235.
Heyward J, Jones CM, Compton WM, et al.. Coverage of nonpharmacologic treatments for low back Pain among US public and private insurers. JAMA Netw Open 2018;1:e183044.
Center for Medicare and Medicaid Services. Advance notice of methodological changes for calendar year (CY) 2020 for Medicare Advantage (MA) capitation rates, part C and part D payment policies and 2020 draft call letter. Accessed February 22, 2019. Available at: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2020Part2.pdf
National Comprehensive Cancer Network. CDC issues key clarification on guideline for prescribing opioids for chronic pain. Accessed August 2,3 2019. Available at: https://www.nccn.org/about/news/newsinfo.aspx?NewsID=1490
American Society of Clinical Oncology. CDC issues key clarification on guideline for prescribing opioids for chronic pain. Accessed August 2,3 2019. Available at: https://www.ascopost.com/issues/may-10-2019/cdc-issues-clarification-on-guideline-for-prescribing-opioids-for-chronic-pain/