my personal edition > pain > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Bringing Balance to Appropriate Opioid Use to Meet Patient Needs: Presented at PAINWeek

By Kristina R. Anderson

LAS VEGAS, NV -- September 12, 2007 -- Clinicians need more practical knowledge when it comes to prescribing opioids, especially in the area of real versus perceived fears surrounding the legitimate use of these drugs, two experts in the field of pain control said here at PAINWeek 2007, the national conference on pain for frontline practitioners.

The two physicians agreed that pain management is very different from typical patient care when acute pain turns the corner into a chronic condition.

Bill H. McCarberg, MD, Founder, Chronic Pain Management Program, Kaiser Permanente, and President, Western Pain Society, a regional section of the American Pain Society, San Diego, California, United States, said that patients never actually believe that an acute health issue will become a chronic condition. "At some point, it dawns on you that you need to do something different."

A "cookie-cutter approach" will not work for pain patients, Dr. McCarberg said, especially the older ones. "You need an entire cookbook approach when it comes to a patient's pain."

Dr. McCarberg emphasised that physicians need to pay particular attention to their elderly patients when it comes to pain because these patients will give up more easily than younger ones. "You need to be persistent in treating their pain and not give up," he urged.

He suggested rotating opioids as part of the treatment package due to the possibility of fewer side effects. He said to always ask the patient what their goals are for treatment. "It's a very simple thing, but mutual goal setting is necessary to protect the physician and the patient."

Panelist Michael J. Brennan, MD, Physical Medicine and Rehabilitation Specialist in private practice, Fairfield, Connecticut, United States, hammered home the contention that it was impossible to measure pain, especially in cancer progression. "You have to assess and reassess the pain patient and be aware of their psychosocial issues."

Dr. Brennan warned the physician audience that it is always circumspect to lay down an opioid treatment paper trail.

"Make sure your patients belong in a pain-care setting. It's the front end of getting to know your patient and it cannot be done quickly," he advised. "And make sure that they have a pre-visit assessment in the framework of medical, social and legal arenas in order to achieve scales of economy. It's an ethical and legal responsibility when it comes to opioid treatment for protracted periods of time; there is no rubber-stamp algorithm. "

Opioid medications, Dr. Brannan said, are the cornerstone of treating pain and the protocol is generally more dogmatic than scientific. He suggested having the patient bring in their parent, spouse or child and inquire about the pain's emotional impact on the family. "I want to see the person most likely to sue me; I want to know how the patient is responding [to treatment]."

He also suggested knowing the referring primary care physician and their threshold for dealing with patients on narcotic drugs such as morphine. "It's personality driven and you need to know the referring doctors like you do the patients."

Dr. Brennan warned physicians not to allow themselves to be lulled into listening to the managed-care insurance companies when prescribing pain treatments. He said these companies may send letters extolling the virtues of some of the cheaper pain medications, such as methadone.

"You don't want to 'Anna Nicole Smith' your patients with methadone," he said, referring to the well-known model whose death was ruled an accidental overdose of the sedative chloral hydrate that became lethal when combined with other prescription drugs in her system. Methadone, according to her autopsy report, was found in her bile.

Dr. McCarberg reminded the group that the abusers will always get their narcotic fixes, but it is important that the older women with osteoarthritis not be left high and dry and in pain due to fears of narcotics abuse. "Otherwise, they'll be moving to Oregon to get access to assisted suicide," he said, driving home the point.


[Presentation title: Bringing Balance to Appropriate Opioid Use to Meet Patient Needs.]]

E-Mail this DGDispatch to a colleague

To print, use this version