PRESIDENT’S MESSAGE

A Responsible Way to Treat Patients and Pain

Ed. note: The following (modified) opinion columnappeared in the online edition of the MilwaukeeJournal Sentinel (JS Online) on March 5, 2013.

The Centers for Disease Control and Prevention recentlyreported that deaths due to prescription medications haveincreased for the eleventh year in a row. In 2010, morethan 16,000 deaths were associated with prescriptionmedications [1]. As tragic as this is for families of a lostone, it would be a cruel consequence if an overreaction tothese legitimate concerns makes it more difficult forblameless patients to obtain relief from excruciatingpain—or stymies efforts to develop more comprehensivetreatments for pain.

Pain itself can be medically harmful, interfering in thebody’s healing process. Anyone who has watched a lovedone cry in agony or experienced such torture themselvesknows that pain can also be crippling, preventing evenroutine activities. In some cases, pain becomes sounbearable that patients escape by committing suicide.

At the American Academy of Pain Medicine (AAPM), ourprimary goal is to ensure that patients receive safe andproper treatment for pain. To prevent harm from all treat-ments and maximize outcomes, the academy believes thisis best achieved through advances in five related areas.

First, the AAPM supports increased scientific research intwo important areas: 1) the effect of opioids, and 2) thedevelopment of more effective non-opioid pain medica-tion. Given the millions of Americans who suffer with pain,we spend a tiny fraction of research dollars on the devel-opment of safer and better treatments. Critics of thecurrent system of pain management should stand with usin calling on government agencies, such as the NationalInstitutes of Health, as well as foundations, universities,and concerned individuals, to help fund and pursue suchdiscoveries. But until research and scientific advancementproduce safer, more effective, and nonaddictive alterna-tives, opioids are the most potent and versatile pain medi-cine available.

Second, it has been implied that organizations that receivefunding from pharmaceutical companies to support paineducation and research cannot be impartial arbitrators onthe treatment of pain [2]. However, in the absence of otherfunding sources, this approach is the only means tosupport these critical public health missions. This is truefor many medical specialties that do not attract fundingfrom foundations or the general public. However, atAAPM, we draw a clear line. We do not permit any outside

organization to interfere in our scientific process. Nocompany or funder can provide any input or otherwiseinfluence the education and training that we provide phy-sicians, patients, and the public.

Third, increased education is critical to the understandingand treatment of pain. Physicians must be aware of bestpractices in prescribing any pain treatment. Patients mustunderstand the proper and safe use of all medications.

Fourth, the public, legislators, and regulators must be ableto separate myths from facts. We support the Institute ofMedicine’s call to raise awareness about treating chronicpain, and we provide programs and materials to educatephysicians on pain treatment [3].

Finally, today’s highly charged discussions about the useof pain medications could result in depriving patients inchronic pain—including the elderly and our returningmilitary—from treatment they need to improve the qualityof their lives. While the visceral reaction to tragic cases ofoverdose and addiction is understandable, we do a dis-service to health care when we stigmatize the use ofopioids in all cases, which discourages patients fromseeking and physicians from prescribing the proper treat-ment for pain.

Many members of the society have a role to play in ensur-ing the proper treatment of pain. Physicians must workdiligently to identify patients who are at higher risk ofdeveloping an addiction or other aberrant behaviors. Lawenforcement should pursue health professionals whointentionally misprescribe and patients who “doctor shop”to traffic drugs. But we should not conflate such dishon-esty and criminal behavior with the legitimate use ofpain medication.

The anti-opioid climate has already resulted in the denial ofmedication to suffering patients. In many cases, doctorsacknowledge a reluctance to prescribe opioids, evenwhen they know a patient is in intense physical pain,simply because they do not want to be perceived asirresponsible or risk regulatory sanctions. And patients insevere pain sometimes forgo asking for help because theydo not wish to be perceived as a drug abuser, or becausethey have come to accept a prevailing view that looksdimly on anyone with a vial of “narcotics” in the medi-cine cabinet.

But in the overwhelming majority of cases, pain medica-tion is prescribed cautiously and responsibly, and dosesare taken precisely as instructed. These doctors and their

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Pain Medicine 2013; 14: 615–616Wiley Periodicals, Inc.

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blameless patients should not be made to feel as if theyare engaging in illicit behavior as they seek to treat whatone patient called “hell on earth”: unceasing, agoniz-ing pain.

LYNN R. WEBSTER, MD*†

*President, American Academy of Pain Medicine†Medical Director, CRI Lifetree

Salt Lake City, Utah, USA

References1 Jones CM, Mack KA, Paulozzi LJ. Pharmaceutica

l overdose deaths, United States, 2010. JAMA 2013;309(7):657–9.

2 Ochoa G. Senate finance committee investigates rise inprescription opioid use. Pain Med News 2012;10(7):1, 16.

3 Institute of Medicine of the National Academies. Reliev-ing pain in America: A blueprint for transforming pre-vention, care, education, and research [report brief].Sponsored by the National Institutes of Health, Wash-ington, DC, June 2011. Revised March 2012.

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