Chronic Pain Update 2013: New Data and Perspectives - Episode 1

Intro to Assessing, Diagnosing, and Managing Chronic Pain

In the series' first installment, moderator Peter Salgo, MD, provides an overview on assessing, diagnosing, and managing chronic pain and introduces the panel, which includes Charles E. Argoff, MD; Christopher Gharibo, MD; Jeffrey A. Gudin, MD; and Joseph Pergolizzi, MD.

Diving right into the controversial topic of opioid abuse, Pergolizzi explains everyone can benefit from the Risk Evaluation and Mitigation Strategy (REMS) program — which includes continuing education for pain management providers, patient counseling resources, and medical guides for reducing the mis-prescribing, misuse, and abuse of extended-release/long-acting opioids — though he believes individuals in the primary care arena will gain more from the program, since Salgo notes there's presently a lack of formal pain management training among the majority of primary care physicians and non-pain specialists that provide the bulk of pain care in the country.

Though the REMS program is still voluntary for physicians, Gharibo believes it should be mandatory, given the growing recognition that pain and non-pain specialists alike aren't educated enough on the topic of incorporating opioids into pain treatment. But Pergolizzi thinks it would be better to keep the REMS program voluntary in order to maintain an emphasis on medical training, though he notes a compliance monitoring program would allow physicians to figure out an "exit strategy" for effectively tapering patients off of opioids if they no longer need them.

Salgo points out that many patients "sit up and take notice" at the mention of stopping pain medications when they’re no longer necessary, even though that's a standard practice for a wealth of antibiotics. Echoing Pergolizzi, Gudin replies that patients view opioid therapy as a never-ending treatment because in the past, physicians would prescribe an initial dose without putting an exit strategy in place.

"Any time that I start an opioid, I always tell (my patients), 'Hey, this is like any other medication. We’re going to start it, we’re going to give it a trial, we’ll escalate the doses, we call it a titration phase, but if you don’t improve significantly from not just an analgesic standpoint but ... from a functional standpoint, this is not a medicine you’re going to stay on long-term,'" Gudin says. "When we kind of phrase it in that light, patients understand that, hey, like any other medication, I might go on or off this."