In July, the AOA House of Delegates revised the AOA's position on intractable pain, first adopted in 1997 (
see box on pages S29–S30). This revision reiterates the AOA's position that osteopathic physicians have a “duty and responsibility to treat patients suffering from intractable pain and/or chronic nonmalignant pain.” The resolution notes that such pain “may be associated with a long-term incurable or intractable medical condition or disease.” Those are the types of conditions covered in Part 3 of
JAOA's 2005 pain management series (available at
http://www.jaoa.org/content/vol105/suppl_4/).
In addition, the position statement instructs the AOA to advocate, and promote to students, residents, fellows and practicing physicians educational resources regarding addictive disorders, diversion awareness and monitoring, and appropriate referral resources, as well as prevention and treatment of pain disorders—a mission that the
JAOA's 2005 series of supplements on pain management is helping to serve. Part 2 in this series, for example, features an article on medical education in substance abuse
1 (available at
http://www.jaoa.org/cgi/reprint/105/3_suppl/6S).
The
JAOA's four-part series also emphasizes the differences between addiction, substance abuse, chemical dependency, and tolerance. The AOA's revised policy statement recognizes these distinctions by including “patients with chemical dependency and/or substance abuse history” among those to whom a “physician may prescribe or administer controlled substances in the course of the treatment for a diagnosed condition causing intractable and/or chronic nonmalignant pain.” This revised policy also recognizes the need for physicians to be hypervigilant in screening these patients for the presence of both drugs of abuse and treatment medication.
The policy statement emphasizes that no physician adhering to appropriate prescribing should be subject to disciplinary action by state medical licensing boards or criminal prosecution by federal or state government agencies for administering controlled substances to treat patients for intractable chronic nonmalignant pain. According to Cato Institute Policy Analysis No. 545 (available at
http://www.cato.org/pubs/pas/pa545.pdf), such is not always the case (
see the commentary on this policy analysis by Frederick J. Goldstein, PhD, beginning on page S2
2).
Also in July, the House of Delegates adopted a policy on long-acting opioid/opiate medication (see box on page S31). The policy recognizes the rights of all patients to have access to intervention and treatment modalities that are medically appropriate to achieve safe and effective control of acute and chronic pain.
The policy further states that “it is in the best interest of all patients not to confine, or seek to regulate Opioid/Opiate medications by limiting their use to a small number of selected specialties of medicine.” The policy contends that such “exclusionary strategies will limit access for patients with medical indications for therapy, complicate delivery of care, and add to pain and suffering of patients in all areas of our country.”
Part 2 in the
JAOA's supplement series on pain management addresses such barriers to pain control for moderate to severe pain as physicians are reluctant to use opioid to treat patients.
3 The complete supplement is available at
http://www.jaoa.org/content/vol105/6_suppl_3/.
Another new AOA policy brings this supplement series full circle on end-of-life care. Part 1 of this series featured the AOA's position statement against the use of placebos in treating patients for pain at the end of life
4 (available at
http://www.jaoa.org/cgi/reprint/105/3_suppl/2S). Now, Part 4 of this series features the AOA's new policy statement on end-of-life care (
see page S32–S34). Like the statement against the use of placebos, the new statement was drafted by the AOA End-of-Life Care Committee.
The new position paper encompasses issues related to informing patients and their families when there is no hope of cure, assuring them of providing comfort through hospice and palliative treatment, and engaging patients in discussions and decision making regarding advance planning for end-of-life care.