Assessment and Management of Pain

Discussion in 'Fibromyalgia Main Forum' started by allhart, Nov 12, 2002.

  1. allhart

    allhart New Member

    Assessment and Management of Pain


    To the Editor: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards, as outlined in the Medical News and Perspectives by Mr Phillips,1 are flawed. In allowing treatment of chronic nonmalignant pain to be included as a "patients' rights" issue, physicians may be pressured to prescribe opiates in cases in which this is inappropriate.

    The article states that there are 50 million people in the United States with chronic pain and 26 million with back pain. Elsewhere, it has been established that nearly 50% of the population reports having chronic pain,2 and back pain occurs in as much as 80% of the population.3 It was stated that there is no "excuse" for not treating these patients with opiates when they are not satisfied with nonnarcotic pain relievers.

    Beyond simple physiologic dependence, patients with chronic pain are at substantial risk for drug abuse and addiction. Prescription drug abuse and addiction are debilitating iatrogenic illnesses. It has been reported that in the United States, there is a 13.5% prevalence of alcohol abuse and a 7.5% prevalence of illicit drug dependence.4 Screening for these disorders has been shown to be difficult and often unsuccessful, even at pain clinics.5

    In as many as 60% of visits to primary care clinics, a physical cause of the patient's symptoms cannot be found.6 Consequently, physicians are often entirely dependent on the patient's stated needs. Moreover, among patients with chronic pain, a substantial prevalence of somatoform pain disorders is expected. Such patients are inclined to exaggerate their symptoms, seek higher levels of treatment, and are particularly vulnerable to addiction.

    Although some studies have found a low prevalence of abuse or addiction, the results may not be applicable to younger patients with back pain, headaches, or fibromyalgia. Finally, the long-term effect of suppressing endogenous pain response has not been adequately studied.

    Encouraging the use of opiates for treating chronic nonmalignant pain in a large vulnerable population can be expected to significantly increase the number of drug abusers and addicts. One need only consider the consequences if opiates were made available over the counter.

    Rather than making the treatment of all types of pain a "patients' rights" issue, the JCAHO should issue guidelines for treatment of chronic, nonmalignant pain. In particular, the committee should recommend caution in the use of narcotics and advocate for the use of multidisciplinary pain clinics.



    George Hansen, MD
  2. allhart

    allhart New Member

    Assessment and Management of Pain


    To the Editor: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards, as outlined in the Medical News and Perspectives by Mr Phillips,1 are flawed. In allowing treatment of chronic nonmalignant pain to be included as a "patients' rights" issue, physicians may be pressured to prescribe opiates in cases in which this is inappropriate.

    The article states that there are 50 million people in the United States with chronic pain and 26 million with back pain. Elsewhere, it has been established that nearly 50% of the population reports having chronic pain,2 and back pain occurs in as much as 80% of the population.3 It was stated that there is no "excuse" for not treating these patients with opiates when they are not satisfied with nonnarcotic pain relievers.

    Beyond simple physiologic dependence, patients with chronic pain are at substantial risk for drug abuse and addiction. Prescription drug abuse and addiction are debilitating iatrogenic illnesses. It has been reported that in the United States, there is a 13.5% prevalence of alcohol abuse and a 7.5% prevalence of illicit drug dependence.4 Screening for these disorders has been shown to be difficult and often unsuccessful, even at pain clinics.5

    In as many as 60% of visits to primary care clinics, a physical cause of the patient's symptoms cannot be found.6 Consequently, physicians are often entirely dependent on the patient's stated needs. Moreover, among patients with chronic pain, a substantial prevalence of somatoform pain disorders is expected. Such patients are inclined to exaggerate their symptoms, seek higher levels of treatment, and are particularly vulnerable to addiction.

    Although some studies have found a low prevalence of abuse or addiction, the results may not be applicable to younger patients with back pain, headaches, or fibromyalgia. Finally, the long-term effect of suppressing endogenous pain response has not been adequately studied.

    Encouraging the use of opiates for treating chronic nonmalignant pain in a large vulnerable population can be expected to significantly increase the number of drug abusers and addicts. One need only consider the consequences if opiates were made available over the counter.

    Rather than making the treatment of all types of pain a "patients' rights" issue, the JCAHO should issue guidelines for treatment of chronic, nonmalignant pain. In particular, the committee should recommend caution in the use of narcotics and advocate for the use of multidisciplinary pain clinics.



    George Hansen, MD
  3. Shirl

    Shirl New Member

    On this one. There are many people on this board that use opiates and are not addicted.

    I would venture to say, since we have so many brilliant drug scientists, why don't they develope a pain killer that is not addictive, and has no horrible side effects?

    I don't take any pain meds, as they all make me terribly sick, but there are people that have to have some help.

    Just my opinion here.

    Shalom, Shirl