Harms Versus Harms: Rethinking Treatment for Patients on Long-Term Opioids.

In 2022, the CDC revised its and encourage clinicians to weight the risks versus harms of continued therapy and empathetically engage patients in patient-centered discussions around continued therapy while avoiding patient abandonment. This commentary discusses how the emphasis on "benefit" will almost always lead to discordance between the patient and provider since many clinicians find little benefit in opioid therapy for chronic pain with evidence questioning its efficacy for chronic pain. This disagreement between patients and providers has the potential to lead to unilateral tapers or patient abandonment and further increase patient harm. Considering this dilemma, we propose a revised framework that emphasizes weighing the harms of continuation of therapy against the harms of discontinuation of therapy when caring for patients on long-term opioid therapy. This revised harm-reductive decisional framework has the potential to retain patient-provider trust and increase opportunities for engagement in evidence-based multi-modal pain treatment, including non-opioid based treatment options.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Lagisetty has no conflicts of interest. Dr Kertesz reported holding stock in Zimmer Biomet and Thermo Fisher and receiving royalties from UpToDate (Wolters-Kluwer). He also held stock in CVS Caremark, in 2020 only. Dr Kertesz served voluntarily on the scientific advisors to the National Pain Advocacy Center, which receives no funds from industry. The opinions in this article are those of the authors alone and do not represent formal positions of the US Department of Veterans Affairs or any other government agency.