Success in Prescribing Opioids for Chronic Pain

Panelists Vitaly Gordin, MD, and Jospeh Pergolizzi, MD, discuss what defines success in prescribing opioids for the treatment of chronic pain.

[victormaitland]

If you follow your doctors instructions, Opiods for Chronic Pain have worked very, very well for me. No addiction of significant side effects !

[dolphinlover]

The numbered pain rating scale is lunacy.

[jessicam]

First of all, as a severe chronic pain patient the past 17 years, the standard pain scale (smiley, sad to crying cartoon faces) is very hard to use.
There are a number of much more informative options out there. Some using color as well as descriptions of what each level of pain might be compared to.
I know something like this would've been much more helpful in determining my pain number than a childlike drawn 'frowny' face.
Especially when I first became injured and had no idea what was happening and what to expect.

Which leads to the fact that there is very little education concerning this.
For years I was told I would "get better" (and expected it) if I would "just do" this surgery or try that treatment or take this pill.

I understand most physicians want the end result for each patient to be completely healed, but when it is, or becomes obvious that's not going to happen, then they need to control their ego and admit to themselves, as well as the patient, there's nothing that will ever take all the pain away.

Personally, I wasn't told it was "unrealistic" to beleive I'd never be completely out of pain again until at least the 6th or 7th failed surgery.

Conversely, physicians should be sure their patients understand the medical definition of "relief".
When I first heard "relief" I thought it meant 'no pain'; not just lowering it to something more tolerable.

As for "improved function", it can take quite some time to find an adequate dose of the medication to get enough releif so the patient can start improving their function and/or start treatments such as PT, massage, etc.

If a patient is in so much pain they can't even shower, how do you expect them to carry out all the needed steps to begin even attending PT, chiropractic, massage or any other treatment that may work in conjunction with these meds and which could then *possibly* lead to slowly tapering down from the "dose escalation" that allowed them to do these things to begin with. "Dose escalation" should not automatically be seen as a red flag issue.
How about actually believing your patient when they tell you their current dose isn't working well enough, instead of assuming they're "drug seeking"- another oxymoron.

I personally have no issue with using body maps, discussing goals and helping a patient look at their situation objectively, bit this needs to be done with compassion and empathy, not facetiously or jumping to the conclusion they need a psychologist because they're not getting the amount of releif they *should* because that's what the drug insert says.

I feel I shouldn't even need to say this, but; every patient is an individual.
They have different genetics, lifestyles, metabolisms, and so on.

I'm not saying that a good psychologist couldn't help with educating the patient by teaching them coping strategies or even with working through the grief and frustration most patients feel when they can no longer function like they used to and have lost their quality of life- but it's insulting, demeaning and frustrating, to most pts I've interacted with, to be told they need psychiatric help.
In their minds, especially patients new to dealing with pain, they 'hear' 'Well the 5mg of hydrocodone I prescribed you 2 months ago isn't working, I give up, you're either not trying hard enough or it must all be in your head!"

Taking the time to clearly explain that this new physician (which also usually costs even more money) will be working "in conjunction" with their PCP/PM and they're not just being handed off to become someone else's problem.

There are so many patients needlessly suffering, who've been 100% compliant with everything they've been directed to try...how many times can a pt be cut open before they're just a walking pile of scar tissue??
What about patients that can still work and cant take the time off for yet another appointment?
What about the Many treatments not covered by insurance and are financially unobtainable?

Are these patients red flagged because if they ask for a higher dose of meds so they can get back to work or playing with their kids?

In perfect world pts would have access to all modalities, be afforded paid time off from work to attend the increasing number of appointments, as well as some type of protection against losing their jobs because of time missed, insurance would allow doctors enough time with their patients to get the full story as well as covering the treatment/s prescribed and they wouldn't be red flagged if their pharmacy can't get their medication and they have to use a different or penalized for ER visits where they'd be treated with respect and not eyed with suspicion.

This "war" turned "epidemic" turned "crisis" has been ongoing for close to 20 years.

Opioid manufacturing has been drastically cut, yet we still see increases in ODs, suicides and further restrictions to the medication.

Will we never see the return of doctors being allowed to do their jobs without govt interference (as the law dictates), without discrimination against a 1000 year old, proven, low side effect medication, or the suspicion of the patients that need it, and start treating those suffering in severe pain, with no quality of life, humanely again??

[JsATA]

What right do they have to stop pain management for chronic pain patients?? Is this America anymore??

[sandrahudson]

I dont understand how people can set and judge a persons pain and if they are in pain ive got L2 L3 L4 L5 plus a herniated disc and lumbosacral radiculopathy so tell me im not inbpain i still work its hard but i do but from but from time to time even pain meds dont help but it keeps me doing to work i have responsibilities to met i want to have surgery to get better but im scared to i want off rhese meds im tired of being classified as a addict

[dolphinlover]

These guys are ridiculous. Like maybe your patient is not experiencing functional success because the meds you give them are not nearly strong enough to control their pain.

[Rae-yvmd]

I smell total BS. Amazing what so called experts will say for money isn't it?

[charlessoukup]

Why is it not discussed that elderly people nearing the end of their lives are a SPECIAL CATEGORY for whom.side effects, even to addiction, are really insignificant, and it is truly OK to continue prescribing opioids for? I am 75, bed bound due to mobility inabilities AND constant back pain. It is likely not possible to restore my vigor and vitality in my aged tissue, but the medical community COULD easily ease my pain to some extent, and be FAR more desirable in quality control, affordability, not supporting criminal activity...why won't you?
I am capable in deciding whether or not I become addicted. And society shouldn't CARE, as I am already not a productive element and have completed my lifetime of effort and vo

contributing to the general welfare. This should be SO obvious, !! Put the effort into prevention & recovery of YOUNG people using opioids as they still have a life to live and a role to play. Give the old who are largely DONE with life some measure of comfort & a reason to continue living our last few years!! Why NOT??

[denawalters]

U walk ar o under in severe pain everyday without a pain med releif go ahead try it.u liars.

[dannywilson]

These guys are judgmental and inappropriate. I have pain from neck down to legs from congenital central canal stenosis. That means, pain is what I say it is.

[klarity]

A psychologist can't relieve physical pain.