Editor’s Note: Lynn Webster, MD, the immediate past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs at PRA Health Sciences, agreed to write the following editorial response to an earlier news story published on Neurology Advisor, titled: Opioids During Pregnancy Affect Birth Weight, Respiratory Health.
Vanderbilt University Medical Center reported a well-known link between opioid use during pregnancy and Neonatal Abstinence Syndrome (NAS) in a recently published study that is quickly gaining traction online. It is sparking a great deal of controversy — in part because there is an already murky atmosphere surrounding opioids.
The article reports infants born to mothers on opioids have a greater risk of low birth weights and premature births. Yet, many clinicians and researchers alike are quick to point out that there are some serious leaps and discrepancies in the way the study is portrayed by the media, and unfortunately for many in the chronic pain community, such discourse can be painfully detrimental to their wellbeing.
It has been reported that the study implies that opioids are responsible for low birth weight and premature birth among infants. Perhaps this is true, but even the study’s researchers point out that the risk to the infant may be less if the mother is on opioids. As every introductory science and statistics course engrains in its students: correlation is not causation. In fact, the researchers tell us that the mothers with premature births and low infant weights were more likely to be smokers, and smoking has long been associated with greater risk of miscarriage, low birth weight, premature birth, Sudden Infant Death Syndrome (SIDS), and birth defects. Therefore, it’s more logical to conclude that tobacco use alone could explain the premature births and low birth weights.
To be sure, investigations like this one by researchers are important — the more we know about what things cause harm, the more able we are to prevent harm. However, we must be cautious in our interpretations of the results.
Ultimately, the conclusion of the media portrayal is inaccurate, misleading, and potentially harmful to the millions of Americans suffering from chronic pain, a community that sometimes relies on opioids to cope with their conditions. Opioids are not, nor should they be the first line of defense against pain. They are not a long term solution for many. Sadly, because public policy and insurance companies have not caught up to the complex needs of chronic pain patients, research remains underfunded and patient needs under-serviced. For those patients, opioids are a last resort; one that most would gladly give up for a pain-free existence.
Media stories like this one wrongfully undermine and stigmatize an already undermined and stigmatized population. They act as a deterrent from the real issue, ignore the needs of chronic pain sufferers, and promote a tainted view of the benefits of opioids, without having concrete facts to support their claims. Chronic pain patients need support. The interpretation of the Vanderbilt study by the media is one more set back against the progression of finding a suitable course of treatment for chronic pain sufferers across the United States.
Lynn Webster, MD, is the immediate past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs at PRA Health Sciences. He is a Pain Medicine News editorial board member and is the author of a forthcoming book, “The Painful Truth.”