Better Treatment of Pain Is Key to Ending Opioid Abuse
Written by Editor   
Thursday, October 05, 2017 07:08 PM

The solution to ending the opioid addiction crisis is “to attack pain.” 

“We are in an epidemic of opioid addiction, but the solution is not just to attack opioids, it's to attack pain," said Eric Schoomaker, MD, PhD, professor and vice-chair for Leadership, Centers and Programs in the Department of Military & Emergency Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md.

One key challenge to addressing pain management is the inability to objectively assess it, he said.

There is no thermometer or measure you can place in any human being to tell their level of pain.  His institution adopted a new pain scale, the Defense and Veterans Pain Rating Scale, that includes questions about how disruptive a patient’s pain really is.

At his institution, clinicians now document chronic opioid therapy status in the electronic health record, educate patients on both the lack of evidence and the risks and benefits of chronic opioids therapy, and collaborate on an agreement of treatment goals and expectations.

It's important to have a way to recognize patients for whom chronic opioid therapy may be inappropriate or ineffective, Morris noted, adding that there are standardized ways of doing that. For instance, The Pain, Enjoyment, General Activity (PEG) scale poses the following three questions:

  • Are serious opioid adverse events occurring?
  • Are significant opioid-related aberrant behaviors occurring?
  • Are chronic opioid therapy treatment goals achieved? 

If a patient’s PEG scores are high, and they aren't improving on the medication, this forces providers to ask why providers continue those medications.  The Palo Alto foundation developed a comprehensive approach to chronic pain that primary care clinicians can use to more accurately determine which patients are not candidates for chronic opioid therapy.