Best Practices for Managing Chronic Pain with Prescription Drugs

This week I will be focused on best practices for managing chronic pain with prescription drugs.  There is no absence of data identifying the issue of prescription drug over-utilization, in society and in microcosm the Workers’ Compensation system.  And likewise there are many resources that document when and how prescription drugs should be used.

I do not know chronic pain.  I definitely know episodic pain: countless sprained ankles from sports, broken ankle and wrist, toe surgery.  I understand first-hand how the use of prescription drugs can calm the body (and my nerves) down so the natural healing process of the body can commence.  Whatever pain I’ve had, I know will go away after a certain point.  What I have not known, and to be honest cannot fully understand, is pain that never goes away from the time you wake up until the time you attempt to go to sleep with no end to the cycle in the foreseeable future.  But I know chronic pain is real, and that people have chronic pain, and that it must be managed by the sufferer in a way that facilitates quality of life.  I am not a doctor, but as an observer I know this to be true.

And in my role as an observer, I am certain that the following is also true from talking to people a lot smarter than me:

1. The level of chronic pain cannot be totally defined based on subjective means like what we all know as the VAS (visual analog scale) of 1-10.  While the patient’s self-reporting of pain is important, objectively identifying and dealing with the source of the pain is even more important.
2. The treatment of pain must be based on scientific evidence.  While the personal experience (education, practice) of treating physicians is certainly key, comparing that to best practices and the scientific evidence of what works (and what doesn’t) is equally important.
3. Without demonstrated functional improvement over time, the method for managing the pain is likely flawed and a reassessment is required.
4. The majority of treating physicians do the right things and their patients get better or at least can maintain a level of function.  We typically review the doctors who are over-treating or are over their head or appear focused on incentives other than the patient’s health (per the CWCI March 2011 report, the top 3% prescribers in California accounted for 54% of all Schedule II prescriptions and 62% of opioid morphine equivalents), but I know the majority are doing their best.

Tomorrow I will discuss some of the clinical sources of best practices.

In this together - Mark

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