Relationship Between Menopause, Chronic Pain Not Adequately Understood
By Annette M. Boyle
SAN FRANCISCO—The VA has focused on reducing the risk of opioid abuse and addiction by issuing guidance that strongly recommends against the use of the painkillers for chronic pain since the implementation of the Opioid Safety Initiative in 2013. While veterans with post-traumatic stress disorder, substance use disorder and obstructive sleep apnea are known to be at high risk, another group appears to face an even higher risk of inappropriate prescriptions for long-term opioid therapy for chronic pain—women veterans.
Researchers at the San Francisco VA Health Care System discovered that nearly 1 in 5 women veterans was prescribed opioid therapy for chronic pain for more than 90 days, and 1 in 9 were co-prescribed opioids and benzodiazepines or sleep aids. They presented their findings at the 2017 meeting of the North American Menopause Society.1
“This is not consistent with current VA guidelines, released in early 2017, which recommend against the use of both long-term opioids for chronic pain and any concurrent use of opioids and sedative/hypnotics,” explained lead author Carolyn Gibson, PhD, MPH, of the San Francisco VA.
The current guidelines recommend opioid use for chronic pain only for intermittent use for limited conditions and only after trying multiple other therapies. Self-management and optimized treatment of comorbidities should be the first-line therapy for chronic pain, followed by the addition of nonpharmacological therapies such as acupuncture. Use of pharmaceuticals of any kind is not recommended, unless the initial options fail to relieve pain and only after discussion with the patient about the limitations of pharmacotherapy. If simultaneous implementation of all these modalities does not relieve pain, the guidelines recommend referring veterans for intensive interdisciplinary pain rehabilitation. Opioid therapy may be considered on a short-term basis in this context.
Gibson noted that data for this study were drawn from 2014-2015, when the VA was escalating communications about the risks of opioid prescribing for chronic pain. “Additional research is needed to determine if prescribing rates for women veterans have declined since 2015, commensurate with increasing education efforts and the release of these new guidelines,” she told U.S. Medicine.