Pain Management with Opioid Analgesics

The "opioid pendulum" swings between providing adequate pain relief and preventing addiction, without solving either problem sufficiently. Policies to address prescription drug abuse in the United States sometimes appear to contradict a practice environment in which chronic pain can be adequately treated. Pharmacovigilance when prescribing controlled substances for chronic pain requires physicians to first make a risk/benefit analysis and then to reassess during ongoing treatment. It is important that physicians document this analysis with transparency so regulators can see that risk is being assessed and managed. Physicians must balance the benefits and risks of COAT so that they can continue to treat pain effectively and improve functional outcomes, while at the same time avoid indiscriminate prescribing. Physicians have an obligation to be thorough, thoughtful, logically consistent, and careful-but there is no realistic expectation that they will always be "right." Advances in the science and art of medicine emphasize rational patient assessment and selection for treatment, the benefits and limitations of pharmacologic and nonpharmacologic management, and careful monitoring. Even small changes to clinical practice can promote safe controlled substances prescribing, and will likely improve the overall standard of care. Copyright © 2009 by Lippincott Williams & Wilkins.