Success in Prescribing Opioids for Chronic Pain

Panelists Vitaly Gordin, MD, and Jospeh Pergolizzi, MD, discuss what defines success in prescribing opioids for the treatment of chronic pain.

During the discussion, Gordin says he considers several factors when treating chronic pain, such as whether the patient shows improvement in function or “continues to lead an inactive lifestyle.”

When that is the case, Gordin questions why a prescription is not working, including possible side effects. He also looks at “red flags,” such as running out of the medication early and escalated doses.

When asked how he handles patients who are not seeing improvement with opioids but still want to take them, Pergolizzi says “it comes down to their perception of care.” Over the course of opioid treatment, Pergolizzi relies on documentation to not only keep track of prescriptions, but also help patients improve their treatment.

Using what he calls a “body map,” Pergolizzi objectively shows his chronic pain patients how other treatments may be more effective for them, since it allows him to point out where they are, where they want to be, and how they can get there.

However, Pergolizzi admits that even this pragmatic approach can be difficult, as patients will have a set idea of what they want their treatment to be based on their pain levels. That is why it is important for patients to consult a psychologist to help deal with the issue of “immediate gratification,” he says.

“Patients want to try to have immediate gratification for a lot of reasons; some are good, some are bad,” Pergolizzi notes. “And we have to have coping strategies.”

Pergolizzi says physicians can work to either establish these strategies with patients or enlist the help of a mental health professional.

“The earlier, I think, the better,” he says. “This way, you can objectively monitor their progress.”