Prescription Pain Meds, Sometimes A Necessary Evil

pain meds

NPR recently aired an interview between NY Times reporter Barry Meier and Fresh Air’s Terry Gross regarding prescription pain medicine abuse and his new ebook – “A World of Hurt: Fixing Pain Medicine’s Biggest Mistake”.

Mr Meier suggested that physicians should be treating the actual cause of pain rather than just prescribing pain medications, that patients can reduce chronic pain by exercise, and questioned the role of drugs like Oxycontin for treating chronic pain.

In fact this is just one of many recent backlashes against doctors for prescribing narcotic medications. Doctors who prescribe narcotic pain medications now face multiple telephone calls from individual and insurance company pharmacists urging them to taper narcotic medications or try something else.

It is true that there has been a marked increase in the use of prescription narcotic medications for chronic non-cancer pain over the last 2 yrs, and this has led to many cases of prescription medication abuse, including unintentional overdose deaths:

narcotic1

Source: Stanos, Phys Sportsmed. 2012 Nov;40(4):12-20.

There have certainly been many instances of rogue physicians writing narcotic prescriptions for cash during walk-in visits in so-called pain pill mills.

Critics of prescription narcotics have cited a concern about the lack of rigorous scientific outcome data showing any long term benefit from the use of narcotics for non-cancer related chronic pain.

Obviously, physicians should be encouraged to investigate the cause of chronic pain and look into treatments other than chronic pain medications.   There are now many “pain management physicians” who will only treat back pain patients with interventional procedures and won’t prescribe narcotics.  However, there iis little to no data demonstrating any long term outcome benefit from epidural injections for back pain.  Furthermore, each of these procedures cost health care carriers up to a thousand of dollars.  There can be no doubt that there are unethical physicians seeking insurance reimbursed for unnecessary procedures, just as their are unethical physicians writing narcotic prescriptions for cash.

There are studies that show chronic pain is under-treated in the community leading to poor quality of life, disability, and healthcare over-utilization.

It is clear that there are many patients currently being treated by ethical physicians for chronic pain with long-acting narcotic medications, and we need to be more careful that increased regulation does not deprive these legitimate pain patients of a necessary evil.  There are many anecdotal examples of physicians who won’t prescribe narcotics or take on new patients who are already taking these medications for fear of state medical board scrutinization or action.

Clearly, we need some kind of a compromise here:

Yes, physicians should investigate the cause of pain, and if possible treat that underlying problem rather than just prescribing pain medications.

Nevertheless, it is not good medicine to let patients suffer needlessly while this is being accomplished.

Physicians need to know it’s OK to prescribe pain meds as long as they take steps to be sure they are doing their best to only prescribe narcotics to legitimate patients without causing drug addiction and overdose:

Ten steps of universal precautions in pain medicine management, from Brennan J: Multidiscip Healthc. 2013 Jul 23;6:265-80.

The media and regulatory authorities needs to do a better job distinguishing appropriate from inappropriate prescription narcotic use.

One wonders if reporters who write about prescription drug abuse have ever been unfortunate enough to experience severe pain themselves and then encountered physicians too afraid to prescribe pain medications?

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s