Use of practice guidelines in pain treatment reduces death risk

Adherence to practice guidelines suggesting that prescribers of opioids engage patients with substance use and mental health treatment reduces mortality in pain management patients, reports a study from Yale University researchers.

Published Feb. 4 in the Journal of General Internal Medicine, the study examined records of more than 17,000 Department of Veterans Affairs (VA) patients receiving long-term opioid therapy. Six percent of the patient group died within a year of initiating opioid treatment, but the researchers found that physicians' use of practice guidelines from organizations such as the American Pain Society and the American Academy of Pain Medicine (which support multidisciplinary care, among other recommendations) had a protective effect.

“Those who received mental health services, substance abuse treatment, and physical rehabilitation were less likely to die within the first six months of starting opioids,” said Julie R. Gaither, a postdoctoral fellow at the Yale University School of Medicine and the study's lead author. “Patients who received mental health care were 50% less likely to die.”

In addition, patients who did not receive substance use treatment services were 2.5 times more likely to die, the researchers found. Use of urine drug testing was not found to have an impact on mortality.