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Helping patients with chronic pain during an opioid crisis

Given the country's opioid problem, how do pain doctors balance their concerns over misuse and overuse with the needs of patients who are truly suffering? That was the focus of a piece over on Vox today, with Stanford pain expert Sean Mackey, MD, PhD, delving into the topic. As writer German Lopez explains:

...[Mackey] takes issue with the claim that research has yet to prove that opioids can effectively treat chronic pain. He agrees that we need more research, but he says he has personally seen some of his patients get better through careful opioid-assisted treatment — although, he clarifies, he uses the drugs not as a first-line response but as “a fourth- or fifth-line agent” for specific individuals.

This is what Mackey emphasizes again and again: Pain patients are different individuals, and different individuals will have different pain management needs. He notes that only a minority of his patients actually use opioids, and many rely instead on some of the 200-plus other non-opioid medications now available in the pain treatment field.

But when patients can be safely prescribed opioids to their benefit, Mackey says, he will prescribe the drugs to them — but, of course, monitor them to ensure they don’t progress to misuse and addiction.

Mackey, who calls the issue a complicated one, goes on to field a series of questions on pain management and the opioid epidemic. The full Q&A is worth a read.

Previously: Shifting the focus from opioids to life beyond pain: A Q&A with pain expert Beth DarnallOverprescribing of opioids is not just limited to a few bad applesThe problem of prescription opioids: "An extraordinarily timely topic" and "People are looking for better answers": A conversation about chronic pain
Photo by stevepb

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