PFROP hard at work in Washington state

In a commentary that accompanied the study in PAIN, Jane C. Ballantyne, MD, professor of anesthesiology and pain medicine at the University of Washington, Harborview Medical Center in Seattle…

“The risk indicators developed for the study could be very important for clinicians. We have scoring systems and risk stratification scores for other disorders. Clinicians may use these risk indicators to identify patients at risk. Then the question becomes what to do. The best course may be not to start those patients on opioids therapy or to take them off therapy. Most pain management experts agree that there are better options for many patients with chronic pain,” Ballantyne said…

Three out of four pain management experts advise using massage for their patients who suffer from constant pain? Expensive injections? Surgery? Tylenol or antidepressants? Please, someone list these “better options” to treat chronic pain.  (Free the weed.)

Based on the recommendations of this and other studies, Washington State’s Interagency Guideline on Prescribing Opioids for Pain was recently revised to caution doctors about prescribing opioids at any dose. The new guidelines extend to the treatment of acute pain, not just chronic pain. Physicians are also advised not to continue prescribing opioids to a patient if they don’t show “clinically meaningful improvement” in physical function, in addition to pain relief…

Perhaps the state with the the most comprehensive guidelines is Washington, which was the first state to focus on physician behavior as a strategy to reduce opioid prescriptions. The initial guidelines were published in 2007 and included a “yellow flag” dose of a 120 mg daily morphine equivalent. The most recent update was released earlier this year and advises clinicians that the risk of overdose doubles at doses as low 20 mgs and increases nine-fold at 100 mgs or more.

David Tauben, chief of the University of Washington Division of Pain Medicine, says the guidelines have helped convince many physicians that chronic pain can be managed without opioids. But it didn’t come easy, he says. Physicians and patient advocates fought the changes, warning that chronic pain patients would suffer as physicians opted to stop prescribing opioids rather than adhere to the new rules. That never happened, Tauben says…

That never happened? Seriously? Okay, if that didn’t happen, what did happen? Can we hear from the patients?

OLYMPIA – Three people take their own lives in Washington each day on average, and suicide remains among the top causes of death in our state. Rates of suicides and suicide attempts went up slightly in Washington from 2006 to 2012…

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