New Pain Medication Guidelines
Fibromyalgia sufferers worry about receiving inadequate pain relief while their physicians worry about drug abuse, the long arm of the government, and the affects of pain medication on overall health. Prescription drug abuse can be just as harmful to one’s body as other types of drug use. If this is a problem that you or a loved one has, please look at the options of treatment. There are many different types of treatment including drug centers. Now these issues have been addressed through the combined efforts of the American Pain Society and the American Academy of Pain Medicine. The two august bodies have developed new clinical guidelines for chronic opioid medication in non-cancer patients suffering from chronic pain.
The February 2009 issue of Journal of Pain contains the guidelines which are meant to offer physicians a formula for the safe prescription of such opioids for their patients suffering from moderate to severe pain. The guideline authors comment that the formula is meant to be applied to those with, “chronic non-cancer pain conditions, including common conditions such as back pain, osteoarthritis, fibromyalgia, and headache.”
The guidelines urge physicians to make regular assessments of their patients’ pain and ability to function. The opioid guidelines also suggest that any suspicion of abuse indicates that the physician may need to increase the number of office visits for these patients. Doctors are encouraged to explore other options for pain relief and are informed that no opioid drug will provide total relief. Doctors need to examine other therapies, including those not including the use of drugs as well as medication from outside the opioid classification, to be used in tandem with opioids. The guidelines also indicate that doctors lacking the skills to prescribe opioids should combine forces with physicians familiar with their use so as to provide optimal care for their patients.
One of the authors of the guidelines, Perry Fine, M.D., professor of anesthesiology at the University of Utah Medical Center, makes the point that physicians should not depend upon their patients’ reports. Other means can help to assess the status of a patient’s opioid drug use including urine tests, pill counts, interviews with significant others, and monitoring the frequency with which the patient requests and fills prescriptions.
The guidelines include three different questionnaires that can help pinpoint which patients might be vulnerable to the risks of abuse, addiction, or inappropriate use of chronic opioid therapy (COT). If the patient should pass all three tests, the physician might then consider a trial with this class of pain medication. However, the guidelines suggest that physicians should discuss the risks of such therapy and obtain their patients’ informed consent before beginning COT. At this point, doctors are advised to discuss their expectations of what COT will achieve and how such therapy will be administered and monitored. It should be emphasized to the patient that such therapy is administered on a trial basis.
Doctors should keep in mind the common side effects associated with COT, such as constipation, decreased libido, and nausea, and make recommendations for life style changes or secondary prescriptions that may ease such effects.
Physicians are encouraged to use non-drug therapies in tandem with COT with the end-goal being treatment of the patient and not just one set of his symptoms. It can take some time until the optimum dose for COT is calculated and patients may have to avoid driving and other activities where cognitive skills are imperative, since the initial treatment with COT may cause some “brain fog.”
The guidelines offer both chronic pain patients, such as those with fibromyalgia, and their physicians a measure of comfort in knowing that COT can be dispensed according to a roadmap which ensures patient safety.