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Letter: Pain management takes patience, time

Prescription drugs.

Prescription drugs. Credit: iStock

Pain management, done well, takes time [“Call to OK bill on Rx opioids,” News, March 19]. That’s the pearl bestowed on me by my physician colleague following his pain management fellowship.

In response to Sen. Kirsten Gillibrand calling for “comprehensive guidelines to tell that doctor or dentist how much medication they can safely prescribe without putting the patient at risk for addiction” — it’s not that easy. Addiction is not caused by exposing a person to a specific number of doses of opioids. It’s a complicated neurological disorder, and pain is a very complex biopsychosocial experience.

Unfortunately, current practice does not allow prescribers ample time for assessment and decision-making. Beyond that, there are additional problems.

Intravenous acetaminophen is highly effective in managing acute pain in the hospital setting. However, the cost is prohibitive at $35 per dose, compared with pennies for intravenous opioids. As such it is often underutilized.

Health care organizations and some health care providers have naïvely simplified pain assessment to focus on the pain intensity score. This is the subjective number a patient reports on a scale of zero to 10. Tying pain medication and opioid prescribing to a numeric pain score — “dosing to the numbers” — has left us in the weeds and enabled inappropriate prescribing practices.

Gillibrand’s call is admirable, but requiring the Centers for Disease Control and Prevention to issue guidelines is not the answer. We have guidelines. We need more time, education, regulatory changes and cost containment for alternative medications.

Diane Santangelo, Stony Brook

Editor’s note: The writer is a nurse practitioner.

 

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