Dr Jeffrey Gudin: How Providers Can Make Sure Patients in Pain Are Treated

The pendulum has swung so far that even patients with cancer pain may not get the appropriate medications they need, but there are things healthcare providers can keep in mind when caring for patients who need opioids for pain, said Jeffrey Gudin, MD, director of Pain Management and Palliative Care at Englewood Hospital and Medical Center.

Transcript

It is not uncommon now to hear reports of patients with chronic pain, or even cancer pain, being denied pain medication. In our effort to combat opioid use disorder, have some of the methods that have been put in place swung too far?

So clearly, treating patients with chronic pain is a major challenge. We have patients who have severe pain despite their underlying diagnosis. Let’s use the most common example of cancer pain versus noncancer pain. The pendulum has swung so far now that even cancer patients can’t get the appropriate pain medications that they need. There’s such a fear that’s been created by the public, by politicians, about opioid abuse and overdose that anybody who takes an opioid is going to become addicted. And that fear is not realistic. Well, I shouldn’t say it’s not realistic, because it happens, but it doesn’t happen in a majority of the cases. So what we as healthcare providers need to do is select the right patient; make sure we screen our patients for a history of addiction, personal or family; screen them for history of psychiatric illness; look at their risk factors for abusing opioids; choose the right medicine. Perhaps if you’re at risk, maybe a bottle of immediate-release opioids is not the right choice of medicine. Maybe a 3-day patch, which is dispensed only 1 at a time from the pharmacy. Maybe a new abuse deterrent opioid formulation might be beneficial. But to throw the baby out with the bathwater and not prescribe opioids for anybody is just unfair to patients who have advanced illness, cancer or not.