Easing the pain: New alternatives, new problems emerge in treating persistent pain

At a glance

Not long ago, facing up to the reality that more than 50 million Americans live with persistent pain, Congress declared the period from 2001 through 2010 "The Decade of Pain Control and Research."

The distinguished researcher Richard Payne, M.D., then president of the American Pain Society, commented at the time, "Pain actually may be the No. 1 health problem in the United States. There is no other condition that costs as much in financial, social, and human terms ... $100 billion every year in lost workdays alone... yet physicians receive minimal education in pain management."

Unfortunately, little has changed for the better over the years, according to Payne himself, currently with Duke University Divinity School, Durham, N.C. Speaking at last year's 11th World Congress on Pain in Sydney, Australia, he repeated the very statistics he cited above. As for the hopeful Decade of Pain Control and Research, it died along with the National Pain Care Policy Act. Its mission was replaced by that of the Drug Enforcement Administration, which focuses on preventing drug abuse via the federal Controlled Substances Act.

Last year, President Bush signed into law prescription drug abuse legislation known as NASPER (National All-Schedules Prescription Electronic Reporting Act). It aims to prevent "doctor shopping"-i.e., patients going from state to state to receive prescriptions for opioids and barbiturates from multiple doctors for the same disease.

According to a spokesman for the American Society of Interventional Pain Physicians-which supported the measure, as did the American Medical Association-"The national program gives physicians and pharmacists access to patient records across the country, indicating what controlled substances are already prescribed and verifying that each patient gets the proper medication."

The automatic reporting aspects of the national database should please pharmacists, remarked B. Eliot Cole, M.D., executive director of the American Society of Pain Educators (ASPE), which trains healthcare professionals in pain management. "The computer system sends an alarm across the country if, say, more than 10 doctors are prescribing the same controlled substance to one patient, or if more than 10 pharmacists are filling the same prescription," he told Drug Topics in an interview.

Yet, Cole added, while DEA claims that it favors access to pain relief medications, it jails physicians and pharmacists for what it calls "illegally prescribing narcotic painkillers" to dying patients. This policy inhibits some physicians from prescribing enough opiates to manage patients' end-stage agony.

Chronic Pain Network

An important feature of the worldwide pain congress in Sydney last year was the introduction of the Chronic Pain Network (CPN), a multifaceted pain education resource for American doctors and pharmacists. It is cosponsored by Ligand Pharmaceuticals and Organon, makers of Avinza (oral morphine sulfate extended-release capsules), an established treatment for chronic moderate-to-severe pain.

"CPN enables healthcare providers to correctly assess each individual in pain and ... collaborate
as a team to provide the most appropriate regimen of care, tailored to each individual," explained Payne, who is chairman of CPN's education board. CPN's Web site is at http://www.chronicpainnetwork.com/.