Pain Specialist: Many Doctors Underprescribe For Chronic Pain
http://hereandnow.wbur.org/2016/02/16/underprescribing-opioids-for-pain
Record numbers of people are becoming addicted to, and overdosing on, both prescription opioids and heroin. (Pixabay)
As part of our continuing coverage of the opioid crisis, Here & Now‘s Robin Young talks with Dr. Howard Fields, who has spent much of his career working with chronic pain patients. He believes many chronic pain patients are actually undertreated for legitimate, life-altering pain, and that their experiences are being left out of the current conversation about opioids.
Interview Highlights: Dr. Howard Fields
On the difference between being dependent on opioids and being addicted to them.
“Addiction really gets to the issue of compulsive overuse of a drug so that it becomes the dominant thing in your life. If you are going to your physician once a month and getting your prescription refilled and you are able to lead a normal life by taking a pill maybe three or four times a day, you’re not addicted. But if you’re spending all your time in the search of a drug, or trying to get the money to buy that drug, or stealing from your friends, or going around in other people’s medicine cabinets looking for opioids, then you’re addicted.”
On the CDC reporting an increase of 300 percent in opioid sales since 1999, but no increase in pain.
“Well I’m not going to argue with the fact from the CDC, I think they’re pretty objective and they’re correct. However, I think the important point for people to understand is that the overuse and the overdose and the deaths from heroin overdose is a separate issue from pain management. The problem is that people who are already addicted are coming in complaining of pain in order to get these drugs.”
How to tell if a patient is genuinely in pain
“Ultimately, you can’t know whether someone is really in pain. However, there are various ways which you will raise your index of suspicion that someone is getting more drugs than they need. So typically, somebody who’s been taking medication for a while will come in and say, ‘Well, I had to increase my dose because it wasn’t working, could you refill my prescription early?’ or ‘I lost my prescription’ or ‘Someone took my pills’ or ‘The dog ate them.’ Whenever you have something like that, you begin to worry. The other thing that I think is very important for physicians before they start a patient on opioid medications which are potentially addicting, although for most people they are not, is to find out whether somebody actually ever had a history of drug abuse in the past. If they use cocaine, do they smoke marijuana, do they have an alcohol abuse problem. If any of those things are present, then it should raise a red flag.”
On the lack of conversation about the underprescribing of opioids
“The greater problem is that there’s a huge reluctance in general of physicians to prescribe adequate medication for people who really are in pain and have a very low risk of becoming addicted. That’s the big problem. I think if you read the actual epidemiological data and the data from insurance companies and health organizations, it suggests that the vast majority of people are undertreated for their pain and I think that that’s in part due to the scare of overdosing and having the drugs diverted and making somebody who never was an addict and never had a drug abuse problem into an addict. My position on that is that’s very rare. I know people are being undertreated for pain. Opioids are the most effective pain relievers we now have. You want to use them optimally, but you want to use them when they’re necessary.”
Filed under: General Problems
We need more from the medical community to step up & speak out w/ actual knowledge & facts! However, I don’t think it is ignorance that keeps many silent as much as it is fear.
I have great empathy for docs., pharms, etc.. that have been forced between a rock & hard place! On 1 hand they have patients that have a legitimate & very real need for opioids; but on the other hand they have to deal w/ the DEA that is ready to pounce & take away everything they have worked so hard to get! So where does the needs of the patient come in?
I think a lot of focus needs to be put on building a strong & trusting healthcare team that includes the patient, Dr., & Pharm. Education is the key as every patient needs to know all they can about not only their cond., but also treatments.
Docs need to make sure that their patients understand the honest pro & cons of ALL treatment options & are aware of REALISTIC expectations & outcomes. Too many times, patients are led to believe that opioids are the cure for all pain & when that 40mg. of oxycontin 3x a day is not making them “pain free”, they think they just need an increase until they are.
This is where many get in trouble & where some docs are falling short as docs need to make sure that the patient understands that being “pain free” is not the goal as that is rarely the outcome. Patients also need to understand that opioids are NOT a 1 size fits all & that opioids alone will not give them the results they want as they work best as PART of treatment & long term use should only be considered a last resort.
I also think that EVERY pain doc should have a CPP advocate/liaison on staff to help with this. A CPP advocate is great at explaining everything, educating on the medical as well as social aspects of being a CPP, plus due to the personal relationship they build w/ the patient, they get insight into the patients life that a doc is unable to get & this greatly helps the doc in seeing early warning signs.
Last & most important is that all team members need to have trust for each other & have no fear of being honest w/ each other about everything. Like if a patient took a couple extra pills during a bad flare, they need to tell their doc w/o the fear of losing their meds. or flagged an addict. That way a doc can properly take action to determine if the patient is in danger of addiction or just needs an increase or change for actual pain.
I’m glad that someone else is saying it. “LEGITIMATE CHRONIC PAIN SUFFERERS ARE NOT ADDICTS,” Real addicts are gaining access to opiates by either faking accidents or buying them on the streets. Everyone who reads this should definitely share on Facebook.
I completely agree!! I think we need to create a Hall of Fame page to list & support all of our pain warriors that are working hard & in many cases, losing everything to fight for & bring awareness to the REAL EPIDEMIC: The ABUSE & NEEDLESS SUFFERING of CHRONIC PAIN PATIENTS!! Anyone else like this idea?
Here is a start:
1. Dr. Ibsen
2. Steve Ariens
3. Dr. Fields
4. Dr. VanDercar
5. Ken Mckim
Just a few off the top of my head that all deserve honor & our support!
We should also have a board of shame that spreads awareness of those that do more harm than good & that are badly misleading people by twisting facts or just making them up! Here are some to start with:
1. Dr Andrew Kolodny
2. Dr. Jane Ballantyne
3. Dr.Mark Sullivan
4. Dr. Drew Pinsky
Giving credit & criticism where it is badly needed & justly due!