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Staying the Pendulum: Moderatism and Prescription Opioids for Pain

Learning From a Track Record of Success in Patient Centered Pain Care

An editorial appearing earlier this week in the Journal of Pain Research and coauthored by senior PAINWeek faculty member Michael Schatman, PhD, CPE, DASPE, advocates for a fresh approach to threading the needle between efforts to address the crisis of opioid abuse and the legitimate needs of patients in chronic pain. In their call for “opioid moderatism” the authors write, “We are concerned that a failure of clinicians to adequately mitigate risk…has resulted in prescription opioids having essentially been ‘litigated away’—resulting in widespread opiophobia and oligoanalgesia. Few argue for a return to patterns of reckless prescribing that was one of the root causes of the prescription opioid crisis. However, a more moderatist approach needs to be considered if the opioid pendulum is to ever find a safe yet humane resting place.”

Dr. Schatman and colleagues outline a response they characterize as “a glimmer of hope” in the form of a community based tertiary pain care facility called Boston PainCare. Described as being neither pro-opioid or anti-opioid, but instead pro-patient, the facility embraces patient centered risk mitigation and an interdisciplinary model of care employing functional and behavioral interventions as core treatment modalities. A carefully administered Medication Management Program—that can include chronic opioid therapy—is  positioned as ancillary to engagement of the core treatments, the success of which is indicated by no overdose fatalities among program participants over 11 years of operation. The authors conclude that “…draconian laws and policies of legislative and regulatory agencies need to be replaced by increased prescriber responsibility, such as that practiced at Boston PainCare” and that “…the numerous stakeholders in the opioid wars need to continue to work toward rapprochement, recognizing that many of the leading players in the opioid wars are key opinion leaders (with) much to contribute to finding a solution to this unprecedented social problem.”

Read a summary of the editorial, with access to the full article.

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