Pharmacotherapy

“The fear of regulatory scrutiny by physicians and other providers is a well known barrier to appropriate opioid prescription in the management of acute and chronic pain. In her article, Dr. Rospond, provides the reader with a brief review of the problem and, more importantly, strategies to limit personal risk while providing optimal care to patients in pain.”

—Charles D. Ponte, PharmD
Department Head

Raylene M. Rospond, PharmD, FCCP, BCPS

On Sunday, July 26 1998, Doonesbury captured the essence of the pain management tightrope when, in response to the statement “You know, Doctor, I think Mrs. Davenport is still in a lot of pain…. can’t you just increase her morphine dose?” The doctor replied “Nope. Your dear friend has the misfortune of dying after 1914, which was the last time physicians had full discretion in prescribing narcotics.”¹ In 2007, this cartoon might be a statement on the impact of the insurance industry on the practice of medicine, however, it can also be a statement on the affect of regulatory oversight on the practice of pain management.

The Problem
Pain is one of the most common problems experienced by patients in the United States and affects 50 million Americans.² Chronic or recurrent pain affects 57% of adults in the United States creating the need for these individuals to implement lifestyle changes in order to accommodate the pain.³ The burden of chronic pain affects society as well as the individual, and costing over $100 billion annually in lost workdays, medical expenses and other related costs.⁴ The “Americans Living with Pain Survey” in 2004 found that, of persons employed and living with chronic pain, 41% reported that their chronic pain adversely affected their ability to put in a full day’s work, while 27% had difficulty in getting to work.⁵ Even if these individuals get to work, reduced job performance results in another $61.2 billion dollars lost annually.³

Despite suffering from pain, 44% of the people did not seek professional assistance for several months. Half of those patients who finally visited their doctors did so because the pain became unbearable. Although every healthcare professional treating these patient would define the treatment goal as optimal pain management, greater than 40-50% of routine patients fail to achieve adequate pain relief.⁶ In a recent study of 805 chronic pain sufferers, over 50% had to change physicians to achieve relief, either because their original physician was unwilling to treat pain aggressively, did not take the patient’s pain seriously, or had inadequate knowledge about pain treatment.²

Please refer to the June 2007 issue for the complete text. In the event you need to order a back issue, please click here.