I have it as a Word document, but didn't want to send the list an "attachment." However, if someone wants the formatting as it appears in Word, I'll send it to you individually as an attachment.
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Ethical and Legal Aspects of Pain Treatment ------------------------- L. Jean Dunegan, MD, JD, FCLM
-- ------------------------- May 2, 2001JCAHO standards for pain treatment: http://www.jcaho.org/
States' efforts - Intractable Pain Treatment Acts State Medical Board guidelines State Pain Commissions Oregon - first state to sanction a physician for failure to adequately treat pain California - malpractice case for failure to adequately treat pain; going to trial this summer There are no known cases of a physician being sanctioned for prescribing opioids; sanctions have been handed down for not documenting the treatment plan and the progress made with that patient toward improving the quality of the patient's life
Article by Dr. Dunegan: http://www.mmhc.com/nhm/articles/NHM0011/dunegan.html
Physicians - Fear of harming patients Are intimidated by drug controls Fear of adverse collegial oversight Fear addiction (occurrence of addiction is rare) Patient will become tolerant of drug and need larger doses (this is rare)
Physical dependence is not an indication of addiction; physical dependence is experienced by every patient who takes substantial doses of opioid medication for more than 7-10 days. Patients should be taken off the medication slowly and gradually
WHO Pain Ladder: http://www.home.eznet.net/~webtent/pain-who-ladder.html
Step 1 (1-3): non-opioids; for mild pain Step 2 (4-6): combination drugs; for mild to moderate pain; "weak" opioids Step 3 (7-10): strong opioids
Step 1: can be easily distracted from mild pain Step 2: can be distracted from moderate pain Step 3: cannot be distracted from pain
Start pain medication appropriate to the level of pain (step 1, 2, 3; or pain scale 1-10) Use the most appropriate type of pain medication for the level of pain Short duration of relief (e.g., Vicodin) or long-acting (e.g., Oxycontin) Step 2 is the level of greatest prescription error
Meperidine - contraindicated in patients with renal problems; can cause convulsions