DrugBuyers.Com: Opinions on undertreated pain??

Thought we might bump this up again with the following interview from Mescape.

Revised Pain Management Guidelines Target Inadequate Pain Control: A Newsmaker Interview With James N. Thompson, MD
Laurie Barclay, MD

Editor's Note: Recognizing that undertreatment of pain is a public health priority, the Federation of State Medical Boards (FSMB) of the United States, Inc., is recommending a revision of guidelines stating that undertreatment of pain, like overtreatment, is a practice violation.

A panel of medical board representatives, experts in pain management and addiction medicine, and state and federal government representatives convened by the FSMB recently reviewed suggested revisions to the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain. Inspired by new insights in pain management, especially regarding the undertreatment of pain, the revised guidelines will be submitted to the FSMB's House of Delegates in May for consideration as policy. Since the original guidelines were released in 1998, more than 300,000 copies have been distributed nationally and adopted in whole or in part by 22 state medical boards.

How should the revised guidelines shape current practice in pain management? To find out, Medscape's Laurie Barclay interviewed James N. Thompson, MD, president and chief executive officer of the Federation of State Medical Boards in Dallas, Texas.

Medscape: What was the rationale for the FSMB recommending a revision of guidelines regarding pain treatment?
Dr. Thompson: Over the last decade, there has been a great deal of progress made in our understanding of pain and how to better manage it, especially regarding the undertreatment of pain. There is a significant body of evidence suggesting that both acute and chronic pain continue to be undertreated. Many terminally ill patients suffer needlessly in their last weeks of life. The revised guidelines encourage state medical boards to recognize that the treatment of pain is a fundamental part of good healthcare.

Medscape: What do the revised guidelines recommend?
Dr. Thompson: The guidelines address the inadequate management of pain and barriers that stand in the way of patients getting appropriate treatment. These barriers include a lack of knowledge among some physicians on what appropriate pain management entails. Another obstacle is a fear some physicians have that they'll be investigated by regulators if they prescribe controlled substances for pain.

The guidelines also encourage state medical boards to consider the undertreatment of pain as much of a violation of the standard of care as other kinds of prescribing violations.

They also stress the need for government to develop a system that prevents abuse and diversion of controlled substances while simultaneously ensuring they are available for legitimate medical purposes. And the guidelines also update definitions of addiction, chronic pain, and physical dependence to reflect current consensus and expertise in the medical community.

Medscape: Are these guidelines likely to vary from state to state?
Dr. Thompson: More than likely, yes. While the guidelines do provide the states a blueprint to follow so that there is some consistency from one jurisdiction to the next, each state adopts policies in accordance with the needs of its residents. Twenty-two states have adopted all or part of the current version of the Federation's model guidelines on pain, and nearly all states have some sort of policy, position statement, or statute about appropriate pain management. I think the states will move to address both the issues of abuse and undertreatment. The wording of how they do this will, of course, vary from state to state, but in general we believe they will come close to reflecting the intent of the guidelines.

Medscape: Which states have begun disciplining physicians for undertreatment of pain, and how is this likely to affect regulatory conduct in other states?
Dr. Thompson: To date, California and Oregon have disciplined doctors for the undertreatment of pain. I anticipate that we will see this number grow in the future as more and more states specifically address undertreatment in their statutes.

Medscape: How can physicians and regulatory agencies best balance the need to treat pain associated with terminal illness or other intractable conditions with the need to prevent addiction, abuse, and diversion of controlled substances?
Dr. Thompson: Our hope is that these guidelines will help state medical boards and physicians treating pain to achieve that kind of balance. The physician who follows these guidelines should not have any problems with their state medical board. The guidelines don't interfere with the practice of medicine, but assure physicians they aren't at risk of being scrutinized by state medical boards if they follow good medical practice. The guidelines set forth good practices to follow when treating pain, such as documentation of records and communication of risks and benefits of medication to the patient. But they don't tell a doctor or patient how their pain is to be treated. If a physician follows these guidelines they should be free from regulatory scrutiny.