Friday, January 8, 2010

Pain Management Fails Due to Rx-Drug Abuse Fears

Millions of Americans with significant acute or chronic pain are being undertreated as physicians fail to provide comprehensive pain treatment, according to recent reviews. The failure is due to inadequate training of physicians, personal biases and, increasingly, fears of prescription analgesic drug abuse.

Writing in The Rx Consultant [December 2009] and the Journal of Pain & Palliative Care Pharmacotherapy [2009], Kathryn Hahn, PharmD, CPE, DAAPM, says the issues are reaching crisis proportions: “We’re in the middle of a storm here and have to figure out some way to navigate through it.” Hahn is associated with the College of Pharmacy at Oregon State University, Chair of the Oregon Pain Management Commission, a State Action Leader for the American Pain Foundation, and a practicing pharmacist specializing in pain management.

“We have more sophisticated pain management techniques available now than ever before,” she says in a news release [2010], “but many doctors are not fully informed about all the options available, and also turn patients away because they’re very concerned about the problems with prescription drug abuse. Because of this, many people suffer needlessly with pain that could be treated, and almost 80% of visits to community pharmacies involve pain issues.” Adequate pain treatment has always been a concern, she continues, in part because it’s not a major part of most physician’s medical training.

Concerns about analgesic abuse are so great that many physicians prefer not to even work with patients who have ongoing pain issues. “I see patients every week who have lost their doctors and don’t know what to do, and these people are scared. It’s particularly bad with elderly and Medicare patients,” Hahn notes. “Prescription drug abuse is a very real problem, we do have to take necessary steps to address it, but right now the pendulum has swung too far and legitimate pain problems are not being managed.”

Long-term solutions will take education and responsibility by all parties involved, Hahn believes, including consumers, physicians, nurses, and pharmacists. Among the steps that may help, she recommends…
  • Physicians and nurses should accept that patients are the final arbiter in determining that something is painful — believe them and work with them on their concerns.

  • Patients should cooperate with their healthcare providers on pain relief plans that may include a range of options, including prescription drugs but also alternative approaches such as chiropractic care, exercise, acupuncture, meditation, implantable devices, massage, or physical and occupational therapy.

  • Looking at medications, there is a range of opioids, over-the-counter pain relievers, antidepressants, and other medications to carefully consider for specific problems.

  • All involved parties should understand that psychological addiction to analgesics is rarely a major concern with proper prescribing as part of an appropriate pain management program.

  • Physicians must stay up to date on the latest approaches and the full spectrum of pain management options, and recognize than pain management is a key part of overall healthcare.

  • Consumers must acknowledge the seriousness of prescription drug abuse problems and safeguard their medications. The unlocked medicine cabinet is the foundation of a cottage industry of drug abuse in America today.
Surveys have shown that at least 30% of patients with moderate chronic pain and more than half of those with severe chronic pain fail to achieve adequate pain relief, Hahn observes. The economic impact of acute and chronic pain exceeds $100 billion per year in the U.S. alone. Among the other remedies, she also believes that health insurers can have an important role to play in reducing prescription drug problems by helping to educate physicians on appropriate analgesic use, restricting off-label uses of readily diverted opioids, and paying for multidisciplinary pain management programs.

> Hahn K. Chronic pain management Rx Consult. 2009;18(11):1-7.
> Hahn K, Colon Y. The roles of pharmacists in pain management. J Pain Pall Care Pharmacother. 2009;23(4):414-415.
> OSU (Oregon State University). Pain management failing as fears of prescription drug abuse rise [news release]. January 4, 2010 [
available here].