Pain assessment and management

SAN FRANCISCO—Effective treatment is available for most chronic pain, but because of a lack of comprehensive pain management training for physicians and the fear that a patient will become addicted to pain killing drugs, chronic pain is often undertreated or goes untreated, according to Howard A. Heit, M.D., a leading expert in pain treatment.

“There are at least 50 to 70 million people in the United States who are in pain and are either not treated or are undertreated. That should not be,” states Dr. Heit, an clinical assistant professor at Georgetown University in Washington, D.C.

“Pain is one of the most common reasons for an office visit, but most physicians are not trained in effective pain management. Physicians need to become more familiar with pain medicines, the disease of addiction and how to evaluate pain patients,” says Dr. Heit who spoke at the AMA’s 20th Annual Science Reporters Conference in San Francisco.

A national survey published in The Journal of Addictive Disease found that 76 percent of medical students reported having little or no training in addiction medicine. An article published in The Journal of American Board of Family Practice stated that approximately 80 percent of the physicians in medical school and in residency programs rated their pain training as either poor or fair. Dr. Heit says pain management and addiction medicine should be included in the core curriculum of every medical school: “Physicians shouldn’t be afraid to prescribe pain medication that allows Grandma to play with her grandchildren again.”

Confusion surrounding the definitions of addiction, physical dependence and tolerance leads to the erroneous labeling of chronic pain patients on opioids as addicts, in some cases. This confusion also causes undertreatment of chronic pain.

“Physicians can be assured that the long-acting opioids they are prescribing for chronic pain do not produce the immediate peak blood level that results in euphoria or a ‘high.’ The drugs are effective at treating pain, but do not cause the sudden rush of euphoria that drug abusers seek. Long-acting opioids are of little use to people who abuse short-acting opioids,” Dr. Heit explains.

“The goal of a chronic pain specialist is to decrease pain, increase function and quality of life and use medicines that do not have unacceptable side effects. The chance of producing a disease of addiction is extremely rare with a valid treatment of moderate to severe pain with opioids.” Dr. Heit also notes that even people with addictive tendencies can safely be treated for chronic pain.

Acknowledging professional concerns about abuse of analgesics, Dr. Heit notes that the goal of doctors and regulatory agencies is to achieve a balance where the pain medicines go to the patients who need them and not to anyone who would abuse, divert or traffic the medicines.

“Find a physician who can help you. As a pain patient myself, I can tell you that people in pain want a physician to whom we can communicate how pain has disrupted our lives. I recommend finding a physician who will listen to you, believe you, evaluate you and treat you properly. If you are not currently in a good patient-physician relationship, you need to find another physician who understands that you are a valid chronic pain patient who is also a responsible citizen who will take pain medication in a responsible manner.”

Dr. Heit adds, “Chronic pain is an important medical condition that, like other medical conditions, can be treated with FDA-approved medications consistent with state and federal regulations. Take the power in your hands to help educate your physician about medicines that will improve your quality of life.”

Editors note: Dr. Heit has received honoraria from and/or serves on speakers bureaus for Purdue Pharma and Abbott Laboratories.

For more information, contact the Science News Department at (312) 464-5374.


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