I thought this might be interesting even for non-medical readers who might be consumers of medical care for a painful condition at some point.
“…(P)hysicians face serious issues when it comes to prescribing opiates. Legitimate worries include not only fears about addicting patients to painkillers, but concerns about sanctions for overprescribing the drugs.
…(But physicians can) aggressively manage pain using all means at their disposal, especially opiates. (S)trategies focus… on setting appropriate dosages, minimizing side effects and avoiding trouble with local medical boards… (N)ew ideas about pain began to alter practice patterns about 20 years ago. Instead of viewing pain as a symptom of disease or injury, he explained, physicians began to view it as a problem in its own right… (C)ontrasting old and new ways of thinking:
- Pain scale
Old: Treat patient pain only when patients rank it 10 on a 10-point scale.
New: Anticipate pain and treat it before it reaches unacceptable levels (usually between four and six on the 10-point scale).
- Dosages
Old: Give a maximum of 10-15 mg of morphine per hour.
New: Use whatever is needed to treat pain.
- Drug choices
Old: Use only morphine or another opiate for pain.
New: Use multiple medications and combine morphine with adjuvant medications for better pain control.
- Act vs. react
Old: Administer treatment “as needed” when patients report pain symptoms.
New: Use a steady-state treatment and build up a steady level of narcotics to provide complete relief.
- Drug action
Old: Use short-acting preparations.
New: Combine longer-release medications with short-acting preparations for incidents of breakthrough pain.”
Feared medical complications such as respiratory depression, somnolence and confusion, or addiction; and concerns about possible regulatory trouble from opiate prescribing patterns hamper physicians’ effectiveness in treating their patients’ pain. The article takes these concerns in turn and suggests ways to address or bypass them. ACP (American College of Physicians) Observer
Here are the “Model Guidelines for the Use of Controlled Substances for the Treatment of Pain” from the Federation of State Medical Boards. The guidelines acknowledge the important role opiates play in pain management and were designed to alleviate physician uncertainty and encourage better pain treatment.
All well and good to address these ‘rational’ if misguided concerns. However, IMHO it is often an irrational, attitudinal reluctance to adequately treat pain that is more at issue. In a strange unconscious sense, physicians may begrudge patients the relief of their distress, since the physician’s identity is so built around the central experience of their training that suffering and deprivation builds professional competency and self-esteem. A workshop to enhance physicians’ effectiveness in managing pain should, in this manner, include a component on managing their own pain in a sense.
