Current Legal Issues Regarding the Use of Controlled Substances for the Treatment of Pain
Michael E. Schatman in Ethical Issues in Chronic Pain Management, 2016
Clinicians must commit to understanding the interplay of law and medicine when it comes to the use of controlled substances to treat pain. The law is not designed to prevent the use of controlled substances to treat pain. The law sets forth boundaries within which clinicians must operate to preserve a medical license or DEA registration. It is important to understand the legal/regulatory materials in one’s state and to assess how they actually protect those who prescribe within the state’s legal/regulatory framework. Using key phrases from legal/regulatory materials in office forms is recommended, as is use of these phrases when writing health care plans to explain prescribing rationale. By using these phrases routinely and in connection with practices that meet or exceed accepted clinical care standards, clinicians are better prepared to demonstrate that they have minimized the potential for abuse and diversion of controlled substances, and prescribed for a legitimate medical purpose within the usual course of professional practice. None of these measures can stop the event of a board or DEA inquiry, but it can certainly help determine the outcome—in the physician’s favor. Pain management is a process tied to the individual circumstances of each patient. A practitioner’s clinical rationale and documentation must reflect this individuality within the legal/regulatory framework of controlled substances and their use to manage pain.
Life Care Planning for People with Chronic Pain*
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
The history of pain management dates back to the first known practicing doctors. It has been said that 80 percent of patient problems prompting a visit to a physician are the direct result of some form of pain—acute, subacute, or chronic. However, most recently, with the advent of chronic pain management programs, more comprehensive multidisciplinary team management for chronic pain and the associated disability/psychological stress/depression and subsequent functional loss have developed. Pain management centers are present in nearly every major metropolitan area in the United States. Pain management is a subspecialty recognized by the American Medical Association, and numerous societies offer continuing medical education, seminars, legislative lobbying assistance, and national boards of directors to oversee the problems associated with the disease state now classified as chronic pain. Beginning in 1911, workers’ compensation laws were enacted to require employers to assume the cost of occupational disability without regard to fault (Weed & Field, 2012). These laws have dramatically altered the recovery of the individual injured in the workforce since that time. However, additional aspects involving litigation have become more prevalent in the last 20 to 30 years. Because of litigation, an adversarial role between the workplace and the injured worker often develops.
Low-Dose Naltrexone
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
The treatment for pain should be individualized for each patient depending on the pathology and symptoms. The goals of pain management therapy are to improve the patient’s level of functioning, decrease pain perception, reduce the use of medications when possible, and improve the quality of life. Traditional medication therapies for pain include the use of NSAIDs (e.g., ibuprofen, naproxen), non-opioid analgesics (e.g., acetaminophen), tricyclic antidepressants (e.g., amitriptyline, imipramine), and anticonvulsants (e.g., gabapentin). These treatment options focus on reducing the inflammatory response to pain stimuli as well as inhibiting afferent pain stimuli by acting as ligands of alpha-2-delta voltage-gated calcium channels in the CNS. Low-dose and ultra-low-dose naltrexone (ULDN) have been investigated for the management of pain, complex regional pain syndrome (CRPS), and painful diabetic neuropathy with encouraging results.
Preclinical discovery and development of oliceridine (Olinvyk®) for the treatment of post-operative pain
Published in Expert Opinion on Drug Discovery, 2022
Ammar A.H. Azzam, David G. Lambert
Designing high affinity, highly selective MOP opioids has been the mainstay of opioid-based analgesic drug design for many years. Bearing in mind that as well as analgesia opioids also produce a range of side effects, is this the right approach? Side effects include opioid-induced respiratory depression [1], nausea/vomiting, constipation, tolerance, and addiction/abuse [2]; these side effects are problematic for the individual and wider society. Societal impact is based on rewarding action leading to abuse; this fuels the opioid epidemic [3]. Pain management is a significant subject in pharmacotherapy and a major part of clinical practice in primary, secondary, and tertiary care settings. Pain can be acute (less than 3 months duration) or chronic (more than 3 months duration). Despite poor/variable efficacy in chronic non-cancer pain, these drugs are often still extensively used. In contrast, the efficacy in acute pain is clear and there is recent UK guidance for perioperative use [4].
Appropriate use of tapentadol: focus on the optimal tapering strategy
Published in Current Medical Research and Opinion, 2023
Renato Vellucci, Diego Fornasari
Chronic non-cancer pain, defined as any non-malignant painful condition persisting beyond the expected normal time for healing (i.e. >3 months)1–3, is prevalent and burdensome1,4, with severe chronic pain defined as pain lasting for ≥3 months that results in high disability and severe limitation5. Chronic non-cancer pain is associated with a range of pathologies (e.g. low back pain, osteoarthritis, fibromyalgia, cervicobrachialgia, radiculopathy, slipped disk, spinal stenosis)6,7 and, importantly, a variety of mechanisms (i.e. nociceptive, neuropathic, and/or nociplastic pain)1,3,4. Goals of chronic pain management, using pharmacologic and non-pharmacologic treatments, include provision of effective pain relief with a balance between benefits and risks for each treatment option4.
Human trafficking in the health care setting: recommendations for the physical medicine and rehabilitation provider
Published in Disability and Rehabilitation, 2023
Shayan N. Bhathena, Mollie R. Gordon, Carolina Gutierrez, Phuong Nguyen, John H. Coverdale, Jeannie Harden
PM&R physicians, also referred to as physiatrists, are well suited to identify, treat and respond to the bio-psycho-social needs of trafficked persons. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) asserts that physiatrists have received adequate training to practice across a range of settings, including but not limited to:Inpatient and outpatient musculoskeletal and neuromuscular diagnosis and rehabilitation.Acute and chronic pain management.Non-surgical spine medicine.Assessments of function, disability and impairment.Rehabilitative care of brain and spinal cord disorders.Post fracture and joint arthroplasty rehabilitative care.Tissue disorders such as burns, ulcers, and wound care.Rehabilitation of polydisease and general debilitation [7].
Related Knowledge Centers
- Chronic Pain
- Clinical Psychology
- Quality of Life
- Pain
- Health Care
- Acute
- Chronic Condition
- Physician
- Health Professional
- Quality of Life
- Pharmacist