A Doctor’s Dilemma: Treating a Patient’s Pain Without Overprescribing Pain Medication
Posted on January 25, 2012The Wong-Baker pain scale chart graces medical offices around the country. The scale’s cartoon faces range from a broad smile (0 pain) to a face with tears (10 pain). Medical providers use the scale to help their patients describe the intensity of their pain.
While primary care doctors help diagnose and treat illness, they also want to keep their patients comfortable and in the least amount of pain as possible. But doctors are struggling with the emotion that their patients need pain relief and the knowledge that prescription painkillers can become a deadly addiction.
The Centers for Disease Control and Prevention (CDC) reports that more people die from prescription painkiller overdose than from cocaine and heroin combined. In 2008, over 14,000 Americans died from an overdose of painkillers. The number of fatalities has tripled since 1999.
Dr. Andrew Kolodny, President of Physicians for Responsible Opioid Prescribing, believes that while doctors are well-meaning, some are over-prescribing painkillers for their patients, who become addicted to them.
Each patient experiences pain differently and the doctor is left to determine how much pain medicine the person should be given. It is difficult for a doctor to tell someone that they do not need as much pain medicine as they think they do.
Across the nation, hospitals and other providers purchased a substantially higher amount of painkillers than they did 10 years ago. In 1999, purchases were 1.8 kg per 10,000 people. By 2010, they were 7.1 kg per 10,000 people.
Reducing and Preventing Addiction to Painkillers
In light of the staggering statistics of painkiller addiction, doctors are trying various strategies to find the best and safest pain relief for their patients. Some doctors are refusing to prescribe excessive pain medication for their patients, but are offering them pain therapies. Some doctors are recommending painkilling alternatives to drugs. Doctors recommend safer therapies such as yoga, exercise, cognitive behavioral therapy, and non-opioid pain medications. If those therapies don’t work, then they might start monitoring opioid painkiller use.
Dr. S Hughes Melton, a family physician in Lebanon, Virginia, thoroughly examines his patients before prescribing pain medication. Melton does his best to find the source of the pain before he begins any treatment. Patients have an X-ray to find the site of the pain and patients are required to take a drug test. Melton also looks at previous and current medications that his patient has taken carefully before prescribing any more drugs.
Dr. Jane C. Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington School of Medicine in Seattle, stresses that long-term treatment with opioid painkillers is inefficient. Too many patients are getting hooked on painkillers and studies show that the ages of these patients are getting younger and younger.
She believes that opioids are best used to ease comfort in terminal patients and to help with acute pain. When patients are prescribed these opioids, physicians should watch for any signs of abuse, side effects, and signs that a patient’s pain has decreased.
Balancing Pain Management
While studies warn health providers that painkillers are being overprescribed, other studies simultaneously report that patients’ pain relief is inadequately treated. An Institute of Medicine report stated that pain prevention and management was insufficient and inaccessible.
One thing that the study stated is agreed upon by researchers in both the Institute of Medicine and the CDC report- healthcare providers need support and training on best practices for safe pain management.
Healthcare providers strive to treat their patients with sensitivity, yet sensibility. As the number of patients addicted to prescription painkillers rise, physicians will strive to reduce that number by monitoring their patients’ prescriptions more closely and providing safer alternatives to manage pain.
