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Learn why pain management is still a pain point

Accreditation Connection, October 14, 2004

A general fear exists among providers and patients that legitimate narcotics use may cause addiction. But this fear is a barrier in the treatment of pain. "The actual percentage of opioids causing addiction in legitimate pain patients is low," says Manina Singh, PharmD, a community pharmacist and manager of education and industry relations for APhA. "You have to be able to differentiate between the drug-seeking and legitimate patients," she says. "As a pharmacist, I watch for individuals who attempt to fill fraudulent prescriptions, visit multiple prescribers, or present prescriptions for unusually large quantities of medications."

Fear of addiction, accompanied with fear of misuse and diversion, has prompted tighter control of narcotics. "Pharmacists have long been the gatekeepers of medication and also advocates of patient care," says Singh. Because of the many uncertainties involved in treating pain, some pharmacists limit access to controlled substances, she says. "Patients can't always find providers who trust them."

Physicians are also reluctant to prescribe pain medication for fear of scrutiny by state and federal agencies, according to a March press release from the Federation of State Medical Boards of the United States. However, under prescribing these medications is considered as much a breach of the appropriate standard of care as over prescribing, according to the group.

The Drug Enforcement Administration and several pain specialists released on August 11 a 48-page report that explains for the first time exactly how physicians and others should treat pain appropriately without attracting scrutiny.

Physicians can legally prescribe pain medications as long as they have an "established" physician-patient relationship, including an examination, treatment plan, and medical record documentation, the report said.

Some precautions physicians and others should take include the following:

• Keep records of the patient's treatment.

• Carefully document the medical history and physical examination that affirmed the need to prescribe the painkiller.

• Carefully document the pain assessments that are required by JCAHO standards, such as PC.8.10. Such documentation "is important evidence of the appropriateness of therapy," according to the report.

• Educate patients about the dangers of using pain medication differently from the way it is prescribed.

To view the report and suggested steps to take when prescribing pain medication, go to www.deadiversion.usdoj.gov/faq/pain_meds_faqs.pdf.

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