Physicians React: Are They Taking Right Path Now With Pain Management and Opioids?
https://www.medscape.com/viewarticle/986356
A Medscape report that explores how physicians prioritize substance abuse among leading American social issues also reveals their divergent views about a proper role in pain management through opioids.
The Centers for Disease Control and Prevention last month updated its guidelines for prescribing opioids to adults with acute and chronic pain. In part, the new guidelines 1) urge clinicians to maximize use of nonopioid therapies, 2) support lowest effective dosages and immediate-release drugs when physicians do turn to opioids, and 3) ask doctors to prescribe no greater quantity of opioids than needed for the expected duration of the patient’s pain.
Some survey respondents in the “Substance and Opioid Abuse Report 2022: Drugs and Alcohol Are Challenging Problems for Physicians and Their Patients” believe doctors still overfocus on pain management and 0-to-10 pain scales, even during the nation’s opioid crisis.
“It’s easy to become addicted to opioids when [physicians are] using a pain scale in the hospital and stating that post-op patients should be encouraged to use meds when they are at a 3,” an ob/gyn said. “If patients were told to expect significant post-op pain going into surgery, then they would have appropriate expectations post-op.”
“Our MIPS forms tell us that we need to present a plan if a patient complains of pain greater than zero,” a rheumatologist respondent added. “Primary care people feel compelled to treat pain. This has resulted in a far more cavalier use of opiates, because other medications have failed.”
And a toxicologist felt continuing “pressure on doctors for their overprescribing during the opioid crisis” would be a positive for society.
Beware Unintended Consequences
But some physicians in the Medscape survey felt the pendulum needs to swing back to more aggressive pain management, including prescribing opioids when appropriate. “Chronic pain and cancer pain patients are often undertreated by MDs, pharmacists, nurses, and support staff,” one internist argued. “These caregivers are not educated properly on pain control, and that is so unfortunate.”
A number of other doctors pointed to unintended consequences for which they said champions of stricter oversight of opioid prescribing cannot avoid responsibility.
“I think the government’s crackdown on physicians…has actually worsened” the opioid crisis, a gastroenterologist said. “Now, people are more often going to the streets and are getting fentanyl-laced drugs, resulting in accidental deaths. It’s a big problem.”
That viewpoint was backed by an orthopedic surgeon.
“Discouraging legal prescriptions doesn’t cure opioid use disorder,” he argued. “Other doctors and I are afraid to prescribe opioids, which is a boon to the illegal drug trade. Opioid prescriptions have been nearly cut in half in 10 years due to the new guidelines and rules, but overdoses and illegal opioids have nearly doubled.”
Filed under: General Problems
We allllll warned them,,ALLLL OF US,, told them 8 years ago,,this would happen,,more o.d’s.,,more suicides,,more death,,,and that is exactly what is happening..Our demented addiction psychiatrist told our government we were big pharma reps,addicts,and our MEDICINE opiates really don’t work,,A LIE,,,,,,Kolodny,the government so-called expert,did NO research on the medical history OF ANY OF US..Nor how his demented police public policy would affect the very people its forced upon..He did no research at all about any of us,our medical history’s ,,nothing,just reckless took away the MEDICINE,,that allowed us to live life,via the lessening of our physical pain from our MEDICAL condition.This display of reckless behaviors shows a complete disregard for human life…Kolodny showed the world,,his reckless disregard for human life,,what happens ,when you allow a reckless ,demented mind in possession of power to make policed public policy for $$$$..$$$ for his addiction psychiatry business,$$$$,for the DEA asset forfieture,$$$$
for the decrease in any malpractice suits for true pain/suffer via allowing all doctors to claim,” addiction,as their ,”out” to justify torturing their patient to death,,$$$
for his demented consulting fees,,$$$ for his Physician Reciprocal Insurance company.Why this huge conflict of interest was never acknowledge, only the corrupt know why..Thus why it is written America put $$$$ before the welfare of its medically ill patients,,,and we do,,u can thank Kolodny for a good part of that dive in the quality of care,or lack of, Americas healthcare system,,Please tell me ,how,torturing your medically ill till death takes,via denial of access to EFFECTIVE physical pain relief SO
death takes the patient,,,is for the ,”greater good,” of society as a whole???,,its not,,we might as well call ourselves animals,,,,maryw,
Yes, of course! Just tell people that you plan to leave them in significant levels of pain after a surgical procedure! What could go wrong there? I know that I would be canceling any surgery with a surgeon that told me they planned to leave me in agony afterward, even if I were a normally healthy person. That’s not exactly an effort in trust building. So you’re going to cut me open, poke around in there, slice and cauterize, then staple or stitch me back up and I’m supposed to just suck it up, Buttercup? Not really, no. But then again, the last gyn I had was the stuff that pain patient’s nightmares are made of, so I guess I shouldn’t be too surprised.
Then we have the Rheumatologist, who appears to be terribly confused by compassion, mistaking it for being “cavalier” with medications that improve quality of life in the portion of the pained population that they see within their practice. Sounds like they could use some further education on the difference between overzealous prescribing of medication and appropriate utilization. But hey, a little virtue signaling never hurt anyone, right? Except us, and we obviously don’t count according to the misguided perspectives of some. Pointing the finger at Primary Care physicians for taking up the slack in regards to treatment of pain, when specialist doctors refuse to acknowledge and address said pain and thereby attempting to paint yourself as somehow morally/ethically superior, is just gross.
Lastly, we have the toxicologist, who spends all day looking at the substances that can kill us. Once again, completely ignorant of appropriate utilization of medications. I forget how the actual saying goes, but this statement put me in mind of the adage warning against going through life like a hammer because everything starts to look like a nail. Anyone who would think that it’s a positive that doctors are being subjected to what they refer to as “pressure” (I prefer the term “persecution”, personally), is evidently thoroughly ignorant of the situation. Of course, they’ll never have to worry about being unfairly targeted so really, no surprise that it’s all roses in their woefully uninformed opinion.
What is perhaps most disturbing is that these cited statements are representative of the viewpoints held by a wide range of providers, likely in large numbers, in specialized medicine. The fact that none of them, aside from the unfortunately opinionated Rheumatologist deals with painful conditions as a general rule, speaks volumes. I am aware that Gynecologists often see women for specific health conditions that can be very painful. However as a woman, I have yet to find a gyn that has ever displayed much compassion for the level of pain that women can experience from those types of health conditions. Having been utterly debilitated by an erratic monthly cycle since day one, I would’ve thought someone out there would understand, but that hasn’t been my experience. I’m sure there are some kind and compassionate gyn’s out there, don’t get me wrong. It’s just that I have never met any of them and as I said, the last one I saw left me quite literally traumatized by her inexplicable, inexcusable actions. Perhaps I’m a little biased, but with statements like the above, I don’t wonder why.
This article is great. Kudos to Medscape. On the other hand, Steve, have you seen the Medscape article; “Dear Doctor?” If you haven’t, I have it. I’ve gotten it FOUR TIMES in the past two days.
How does a doctor know when he has reached the proper upper titration, unless he waits for unconsciousness of the patient or the patient tells the doctor he’s reached enough! I’ve had to tell the doctor I’ve had enough a couple of times, but they never ask me if I am receiving enough pain reduction. I have always reminded the doctor that I am not receiving enough pain reduction to let me relax When the doctors don’t listen, pain relief is pretty much unachievable!!
I hear that! I’ve had to do the same thing. I’m still at the same inadequate dosage.