September 2011

The author recounts how her struggles as a patient being treated for a chronic painful condition, and learning that thousands of other women have had similar experiences, opened her eyes to the effects of gender-based disparities in pain treatment and led her to take a lead role in advocating for change.

An algorithm-driven resource can aid in promoting treatment adherence and identifying high-risk patients in opioid therapy. Anecdotal accounts and clinical studies alike indicate that primary care physicians and other clinicians who use opioid medications to treat patients for chronic pain are struggling to implement uniform and effective abuse and misuse assessment and risk management protocols.

Gary Jay, MD, DAAPM, FAAPM, a neurologist and independent consultant in Raleigh-Durham, NC, discusses the challenges associated with properly diagnosing migraine, reviews the overlapping symptoms that can lead clinicians to confuse migraine with other headache types and misdiagnose a patient, and explains the potential consequences for patients who have been misdiagnosed. This interview is based on information Dr. Jay presented during a presentation titled "Differential Diagnosis of Migraine Headache" at PAINWeek 2011.

Do primary care physicians who are not geriatricians under-treat chronic pain in older patients due to lack of education, concerns over adverse effects, and other barriers to the use of opioids?

Although the evidence appears to indicate that addiction rates are quite low among chronic pain patients treated with prescription opioids, clinician and patient fears regarding addiction continue to play a significant role in the treatment decision process. Proper screening, risk assessment, and ongoing monitoring remain the keys to minimizing addiction risk and ensuring effective pain management.

Communication skills, a better understanding of the presentation of chronic pain, and a methodical approach to evaluation and treatment are the keys providing better pain care. Chronic pain is a common clinical presentation, yet many physicians remain apprehensive and feel reluctant about caring for patients with this condition.

The increase in the number of young children seen in the emergency department and/or admitted to the hospital due to inadvertent ingestion of prescription and OTC analgesics can be only partially explained by the increase in prescriptions and sales of these medications.