Principles of Opioid Management of Pain

Principles of Opioid Management of Pain (full text) – by Joel Hochman, M.D. and the membership of the NFTP and the Pain Relief Network (PRN); TPPCD listServ; Summer 2006. Republished: 2009-03-12. Added links to recent pain guidelines: 2009-03-14.

Permalink: http://doctordeluca.com/wordpress/archive/principles-opioid-pain-rx/

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Note (March 2009):
I am republishing these Principles of Opioid Management of Pain, by Dr. Joel Hochman, et al., because of the explosion of deeply flawed and misguided “Guidelines” for pain management in recent years. This document stands alone in meeting the textbook or reasonable physician standard of care for pain management while not violating core ethical obligations of the doctor-patient relationship. Hochman’s Principles are useful, I think, for comparison when studying recently promulgated Guidelines, such as:

• Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain – APS / AAPM, 2009 [Abstract] [Full text PDF],
  and the infamous Washington State
  
• Interagency Guideline on Opioid Dosing for Non-Cancer Pain – WA AMDG, 2007. [Full text PDF]

See also:
The Distortion of Medicine and Confusion of Standards – DeLuca, 2008,
and,
PRN files State Tort Claim vs. WA State – Laura Cooper, PRN, 2008

..alex…

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Excerpt from the Principles of Opioid Management of Pain:

2. Standard pharmacological resources (such as the Physicians Desk Reference) should be utilized in the choice of initial doses… These standard resources do not reflect [individual] variations and are not the final word on dosing…

a. As no maximum dose or schedule exists for any opioid medication, the maximum dose or schedule utilized shall be determined only by clinical outcome…

c. Physiological dependency shall be carefully explained to patients and distinguished, in writing, from Addictive Disorders…

d. Pseudoaddiction, in which the patient seeks additional medication because they have not been prescribed sufficient medication to contain their pain, shall not be misidentified as addiction, and patients suffering this situation shall not be pejoratively labeled as ‘drug-seeking’.

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Background resources:

Chronic Pain and Opioids – Debunking the Myths – Frank Fisher.

‘High Dosage’ Opioid Management – Considerations in Treating Intractable Pain – Joel Hochman, MD, Executive Director: National Foundation for the Treatment of Pain; Practical Pain Management; 5(2); page 39; 2005.

The Role of Opioids in Cancer Pain Management – M. Fukshansky, M. Are, A.W. Burton; Pain Practice, 5(1), page 43; 2005.

White Paper on Opioids and Pain: A Pan-European Challenge – compiled by OPEN Minds – Opioid and Pain European Network of Minds; 2005.

Chronic Pain: I – A New Disease? ; II – The Case for Opiates – Daniel Brookoff; Hospital Practice; 35(7), page 45 / 35(9), page 69; 2000.

Pain and Opioid Therapy archives

War on Doctors Academic, Legal, Official-report archives

Drug War Journalism and Advocacy archives

WAR ON PAIN SUFFERERS Special Collections – Introduction and Table of Contents

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