Abuse of opioid prescription pain medicine is a major societal problem. This should be no surprise to anyone who lives in a rural area or who follows the news. It is important to understand the difference between chronic and acute pain management. Another distinction which may be missed by politicians and policymakers is the difference between self-limited pain such as that which occurs after surgery or injury or which can be treated effectively by surgery and that pain which has no mechanical solution. In 33 years of practicing surgery I have almost never seen a patient developed drug dependence after postoperative opioid treatment when the surgery was curative.
I applaud the CDC’s recent promulgation of guidelines
http://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf and the editorial in the New England Journal of Medicine
It is important however this is interpreted correctly so that physicians not be placed in an impossible position. It is our sacred duty to relieve pain and this has been emphasized by the Joint Commission. Institutions can be cited for an inadequate pain relief program and hospital Quality Assurance programs may cite individual physicians who do not provide adequate pain relief for their hospitalized patients. It is important that decision-makers understand the difference between self-limited pain and that pain that has no specific solution so that they don’t interpose themselves between the physician and patient. Enlightened physician leadership in adopting local practice parameters is essential.
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