In Pain Practice, Senator Gene Yaw Is Wrong

State Senator Gene Yaw means well when he suggests teaching all doctors the pros and cons of opioids. In theory, I appreciate what he’s saying and am pleased to see his support for broader education about opioids and pain management.

Medical Students Receive One Hour of Pain Management Education —

Veterinarians Receive More!

I often lament the fact that medical students get only about an hour of education in pain management (inclusive of opioid therapy training) before they become doctors. Veterinarians get more training in how to treat pain than medical students. The failure to teach medical students about treating pain has to be corrected before we can solve the opioids crisis.

However, a doctor can only evaluate the pros and cons of opioids in the context of a specific patient’s clinical needs. What’s right for one patient may well be wrong for another patient. The pros and cons are different for each patient.

Understanding the advantages and disadvantages of opioids must happen in a clinical setting of pain management. Good decision making requires not only compiling a list of the good effects and bad effects of opioids that can occur but, also, understanding whether they might occur under different conditions.

Critical Questions in Pain Management

In deciding the pros and cons of prescribing opioids, a doctor has to ask the patient or him or herself some critical questions including:

• What’s the cause of the patient’s pain? Are there any other treatments that can be tried first?
• What’s the patient’s risk of opioid misuse or abuse?
• What other health medical problems does the patient have?
• How long will the patient need an opioid?
• What are the risks of the alternative therapies, and how do they compare in terms of risk and effectiveness?
• What are the risks to the patient if an opioid is not prescribed?

The answers to those questions and others will apply only to a specific patient, and they will only apply at one particular time.

If the same physician were to see the same patient six months later, or two years later, the answers likely will change. The doctor’s decision about whether or not to prescribe opioids might change, too, based on those answers.

In other words, determining the pros and cons of opioids is always the result of weighing the risks/benefits for a given patient at a given time. The decision to use or not use an opioid cannot apply to everyone in all situations.

By way of analogy, how would a physician evaluate the pros and cons of chemotherapy for a patient? It is not possible to have a discussion about the potential benefits, and the potential harm, of chemotherapy without knowing a lot about the patient and type of cancer he or she has.

Chemotherapy may not be appropriate for a given cancer, but may be appropriate for others — or a patient may have a medical condition which would make it too risky to administer chemotherapy. You’d have to take into consideration the specific needs of a particular patient with each specific cancer to discuss the pros and cons of chemotherapy for that patient.

And what is the risk of not providing the chemotherapy?

Certainly, you can have a theoretical discussion about whether opioids (or chemotherapy, or any other type of treatment, for that matter) are potentially a treatment to consider. But you can’t evaluate the pros and cons of treating someone with opioids in the absence of more information specific to a patient.

What Are The Risks of Not Providing Pain Therapy?

To further complicate matters, it would be wrong to list the good and bad effects of any drug without also citing the good and bad effects of not providing the drug.

What would happen if a pain patient were not given access to opioids? Would that individual be able to live with the pain, or would that person be forced to find alternative painkillers — perhaps on the streets, where the risks of taking the medication would be even greater than if a physician had prescribed it?

The risk of addiction to opioids wouldn’t be eliminated just because a physician refused to prescribe painkillers. Opioids produced by a cartel, either domestically or overseas, can be just as addictive as (or perhaps even more addictive) than Pharma produced drugs.

So Gene Yaw means well when he suggests that physicians should learn about opioids to treat pain. I agree, and I stand with him in the hope that, one day, all physicians will be knowledgeable in treating people with pain with or without opioids. But, if Senator Yaw believes that memorizing a simple list of pros and cons will be sufficient training, he is mistaken.

Patients Require Individualized Pain Treatment

Patients are individuals that require individualized attention and care. Theoretically, it doesn’t matter what the pros and cons of opioids are. All that’s relevant is what the individual needs of a patient are and whether prescribing an opioid is the right choice, at a given time, to meet the patient’s needs.

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD