The medical community’s focus on global outcomes of treatment, rather than on patient-specific outcomes, is yet another obstacle to optimal treatment for pain. But by having patients actively involved in their management plan, healthcare providers can become more knowledgeable patient advocates with legislators, insurers, and other medical professionals. Because it is not possible to provide complete relief to all patients with pain, education about realistic treatment outcomes is key for both patients and healthcare providers. For example, by becoming active members of their treatment teams, patients may realize improved quality of life despite persistence of a certain level of pain.
Opioids are not appropriate for all patients with pain—for example, those whose pain is mediated through inflammatory pathways, who are more effectively treated with anti-inflammatory drugs. Nor are opioids appropriate for patients who may misuse/abuse/divert these medications. However, this obstacle may be resolved by drugs in development that utilize novel tamper-resistant and abuse-deterrent technologies. Furthermore, physicians’ prescribing of opioids has become limited not only by their abuse potential but also by the increased possibility of litigation and changes in medical insurance and governmental policies.
In the past 10 years, adolescents and young adults have escalated their abuse and non-medical use of opioids. In 2006, 10% of youths aged 12 to 17 were current illicit drug users, with 3% using prescription drugs nonmedically, and nearly 20% of young adults aged 18 to 25 used illicit drugs, with more than 6% using psychotherapeutics nonmedically. At the same time, many (or even most) parents remain largely unaware that their children may be abusing drugs.
Roundtable participants agreed that many of these obstacles to effective diagnosis and management of pain could be resolved by making pain medicine a primary medical specialty. As a positive first step, they said, a 2-year fellowship or 4-year residency program in pain medicine should be established in the medical curriculum. Training for pain medicine specialists would include all facets of pain management (for example, anesthesiology, physiatry, psychiatry, rehabilitation). The benefits of this expertise in pain medicine could then be extended by incorporating pain management principles into other programs, promoting learning for nurse practitioners, physician assistants, and other allied health professionals.