March 7th, 2014

  When Experts Are Wrong

     What lessons can be learned from the recent acknowledgment by a noted pain management physician that he underestimated the addictive potential of opioid pain pills? To me it is a reminder to challenge every reassurance about new medications or new uses of old medications with two questions about pain medications:

       1. How good is the evidence supporting the reassurance?

2. What are the connections between the person giving the reassurance and the company that manufactures the medication?

These may be difficult questions about pain medications to answer. Looking at research data critically can be daunting, but looking at simple things such as the number of subjects, length of time and whether the studies are controlled and double blind are basic. Disclosures of financial arrangements with drug manufacturers are now required, but are often non-specific and often do not communicate whether the relationship is minor or significant.

One challenge is how to maintain a sense of balance and not to react to this acknowledgment by going to the opposite extreme. I and many other physicians think that at the time that this physician was originally stating his case, pain was in fact being under treated. More medication was appropriate, but the dangers of this expansion, particularly in the area of chronic non-cancer pain, should have been made more clear.

I often get questions from our patients in recovery about how to manage pain medication issues for dental or other surgical procedures. They are often surprised by how much relief they can get from non-opioid medications such as ibuprophen. When medically necessary, opioid pain medication can be used, even for patients with history of opioid addiction, without precipitating a relapse. The critical issue is that appropriate precautions must be taken. Everyone involved should be made aware of the dangers and a reliable person should take over the holding and dispensing of the pills.

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