Doctors office[/caption]Carol Forsloff---One of the greatest conflicts doctors have is in the treatment of chronic pain patients, where on the one hand they are admonished not to addict the patient and on the other hand witnessing ongoing pain and doing nothing can in some ways harm, when the admonishment to physicians is to do no harm.
It becomes a dilemma for doctors, to stay within the safe guidelines, obey the laws, and yet face patients every day with serious, ongoing pain. Many don’t know quite what to do. Why is that?
Pain is the most common reason a patient sees a physician but few physicians have received adequate training to help their patients, according to a Henry Ford Hospital article published in the Journal of American Osteopathic Association.
Statistics give us the estimate of 100 million people in the United States living with chronic pain. The costs for medical care and lost productivity are about $635 billion annually. Every doctor is said to have about 28,500 patients with chronic pain problems. So the issue large and complex. And it’s the primary doctor whose responsibility it is to care for patients with ongoing pain, even though many of these charged with medical care don’t know quite what to do about effectively treating pain.
A study of 117 U.S. and Canadian medical schools learned only four medical schools in the United States offer courses in pain management found that only four U.S. medical schools offered a required course on pain management.
“It’s a major health care problem,” says Raymond Hobbs, M.D., a Henry Ford Internal Medicine physician and senior author of the evidence-based clinical review article in JAOA. “We have physicians who have been well trained and have been practicing a long time, but didn’t receive training in pain management.”
Dr. Hobbs offers these recommendations for physicians , whom Hobbs believes have a “moral responsibility” to help their patients with chronic pain:
• Work in collaboration with a team of specialists comprising primary care, physical or occupational medicine, pain management and mental health.
• Patients being considered for oral opioid therapy like morphine, codeine and fentanyl should be screened for substance abuse using a five-point risk assessment tool.
• Set a threshold dose of 200 mg/d or less of oral morphine equivalents per day.
• Follow the so-called Universal Precaution model that calls for a complete medical evaluation and regular assessments of the four A’s of pain medicine analgesia, activity, adverse effects and aberrant behavior.
Some doctors recommend pain clinics so they have a backup plan that can help their patients which allows them to be in the loop of treatment but not have the primary or sole responsibility for making the decisions about pain. Pain management clinics often rely upon an array of treatment modalities, a number of different types of assessment and a team of specialists. But it remains the doctor who has a central role, and experts believe education in the treatment of chronic pain needs to be part of the ordinary doctor’s training.
