Coalition of Pain Experts Offers Guidance on Measures to Prevent Misuse and Abuse of Pain Medications


PALM BEACH, Fla.—An ad hoc coalition of leading pain specialists and representatives from key clinical and patient advocacy organizations convened in November 2008 to address the growing problem of misuse and abuse of pain medications, and to strengthen support for recognizing chronic pain as a distinct disease state—an important step toward improving the diagnosis and treatment of patients with pain.

The roundtable included representatives from primary care and specialty medicine, nursing, nurse practitioners, and physician assistants, as well as representatives from the American Academy of Pain Medicine, the American Pain Society, the American Chronic Pain Association, National Pain Foundation, the American Pain Foundation, and other leaders in the pain community.

The goals were to review the barriers to diagnosis and treatment of acute and chronic pain in clinical and community settings; increase public awareness of the disparities in pain treatment based on gender, race, ethnicity, and age, and provide recommendations to enable clinicians to overcome these barriers; implement management strategies to provide adequate pain relief for a spectrum of patients, including those who may be at highest risk for medication misuse, abuse, and diversion; and discuss emerging technologies to deter misuse, abuse, and diversion of opioids.

Roundtable participants began by delineating some of the current obstacles to meeting their goals, and then collaborated on possible solutions. One of the major obstacles, they argued, is the inconsistency of guidelines for the diagnosis and treatment of pain, which represent a number of individual organizations and pain societies. Therefore, reorganizing the organizations and societies in the pain community into a single united group could enhance cooperation and eliminate fragmented guidelines and treatment standards. Similarly, the lack of standardized procedures for patient assessments (which should include physical examination and functional evaluation before and during treatment) has led to a lack of outcomes data in pain medicine. Development of protocols for outcomes studies—particularly studies that look at the effects of pain and treatment of pain on function and quality of life—as well as the generation of “best practices” can help overcome these obstacles.
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