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Doctors’ fears of prescription abuse may lead to inadequate pain management
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The number of patients who are under-treated for significant or chronic pain has reached crisis proportions, according to a pain management expert who attributes this problem to physicians’ inadequate training, personal biases concerning pain management and rising fears of prescription drug abuse.
“We have more sophisticated pain management techniques available now than ever before,” Kathryn Hahn, PharmD, of Oregon State University (OSU) College of Pharmacy, stated in an OSU press release. “But many doctors are not fully informed about all the options available, and also often turn patients away because they are 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. We are in the middle of a storm here, and have to figure out some way to navigate through it.”
Chronic pain management remains a challenge in orthopedic surgery, Douglas W. Jackson, MD, Orthopedics Today Chief Medical Editor, told OrthoSupersite.com. “The high-dose pain prescriptions given on a long-term basis and the low rate of curing or reducing patients’ chronic pain addiction problems concern me.”
He added, “The disabled chronic pain patient remains a major management challenge. Too often they are supplied with addicting medications and/or implantable devices as opposed to successful alternative treatments.”
Solutions needed
Hahn noted that some physicians prefer to not work with patients who have chronic pain, and other physicians may fear criticism from others in the medical community if they prescribe high numbers of pain medication.
“Prescription drug abuse is a 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,” Hahn said.
Pharmacists and others also contribute to the problem, which causes needless suffering and fear, particularly in elderly and Medicare patients, according to Hahn.
She offered solutions for improving delivery of analgesic pharmacotherapy, including better education and communication, in two articles featured in the Journal of Pain & Palliative Care Pharmacotherapy and The Rx Consultant.
She recommended better cooperation and communication among physicians, patients, pharmacists and others as a way to solve this growing and costly problem.
“Surveys show at least 30% of patients with moderate chronic pain and more than 50% of those with severe chronic pain fail to achieve adequate pain relief. The economic impact of acute and chronic pain exceeds $100 billion per year in the United States,” Hahn wrote in one article.
Education
Better physician education about pain management is needed since most physicians receive limited training in medical school on opioid use.
They should stay up to date on the latest approaches and full spectrum of pain management options, recognizing that pain control and management is a part of overall health care.
Patients can enhance their results by cooperating with their prescribed pain relief plan and working with and communicating about their pain issues with their current health care provider, rather than switching physicians arbitrarily and frequently, Hahn noted.
Communication
Community pharmacists, often on the front line of this issue, can foster patient-physician communications or be patient advocates.
Hahn recommended such long-term solutions as better education for all those involved and ensuring they take greater responsibility for pain management.
- References:
Hahn K. Chronic pain management. Rx Consult. 2009;18: 1-7
Hahn KL. The roles of pharmacists in pain management. J Pain Palliat Care Pharmacother. 2009;23: 414-418.