Pain care must be patient-centered, integrated, and individualized


Purdue Pharma recently ran a full-page advertisement in the Wall Street Journal and the Washington Post asserting that the company, which manufactures prescription opioids, wants to limit the use of prescription opioids. While this ad may have left some readers confused, one point rang true: “we believe the country needs a new approach to prescribing opioids.”

In its approach to addressing the opioid crisis, Purdue Pharma is encouraging limiting patient access to various treatment options, including limiting exposure to opioids.  The ad stated that Purdue Pharma will no longer promote opioids as an option for pain treatment to prescribers. Instead, the company calls for access to multi-modal and non-pharmacologic options — which are two treatment options that the American Academy of Pain Medicine supports as solutions to addressing this widespread issue.

As the professional society representing the nation’s doctors, nurses, researchers, and other clinicians who are tasked with treating pain, we could not agree more with Purdue Pharma’s statement that we need a new approach to prescribing opioids. To achieve a new approach, however, will require the society to rectify the misconception that treating pain equals prescribing opioids. In fact, there are many treatment modalities in pain management, including non-pharmacological (physical, behavioral, cognitive), pharmacological (non-opioid and opioids), interventional (nerve blocks, ablations, and modulations), surgical, and complementary and alternative treatment. This approach to pain is termed multimodal pain care. In cases where patients have failed to respond to non-opioid therapy but responded well to opioid medications with improved quality of life and better functions, opioid therapy may be appropriate and necessary.

The key is that pain care must be patient-centered, integrated, and individualized. Just as the causes of pain are vastly variable, the ways to treat pain must be tailored to individual patient’s need.  To meet the patients’ need requires accurate assessment and correct diagnosis of each patient’s pain condition, which may be a symptom caused by another disorder or a disease in its own right. Limiting opioid prescription arbitrarily to no more than seven days may not serve the patients’ needs, particularly for those who have severe pain after major surgeries, those with sickle cell disease, those with cancers, and those who have been on chronic opioid therapy for years with significant therapeutic benefit and without adverse effects.

With a sustained national opioid crisis, it is imperative that clinicians are prepared to address and diagnosis proper pain treatment depending on their patient’s needs. There is, however, another critical concern with current approach to pain management, the lack of proper pain management training for medical students. One hundred million people suffer from pain in the U.S., yet, per the Association of American Medical Colleges, there are fewer than 5,000 doctors specializing in pain. The journal Pain Medicine recently covered the gaps in how we train and test our medical students and found that while pain is the most common reason patients seek for care, appropriate management of pain is poorly taught in medical school curriculum and rarely tested in medical licensing examinations. Many students, residents, and educators find the current training landscape for chronic pain management to be inadequate. To begin altering our approach to prescribing opioids, we must start making changes at the foundation of medical training with proper education, certification, courses, and prioritization of pain management.

The future of patient care must be evidence-guided, integrated, and personalized in nature. This is especially true for pain care, and it will require more education options, and physicians, for the public to overcome stigma around pain, opioids, and addiction and for clinicians to help them treat patients smarter and better.

Jianguo Cheng is president, American Academy of Pain Medicine.

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