-- Helen Dynda ( olddad66@runestone.net )At Thu, 3 May 2001, Poutinen, Jay wrote: > >Last night I attended a presentation by Dr. L. Jean Dunegan, a specialist in >Pain Management. She is a surgeon and a lawyer. I summarized her remarks, >and thought it might be useful information to some on this list. > >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. > >------------------------- > >------------------------- >Ethical and Legal Aspects of Pain Treatment >------------------------- >------------------------- >L. Jean Dunegan, MD, JD, FCLM >------------------------- > >-- >------------------------- >May 2, 2001 >------------------------- > >------------------------- >JCAHO 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 >