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From the Phoenix Indian Medical Center, Indian Health Service, United States Public Health Service, where Mr Rasor is on staff in the Department of Physical Therapy and Dr Harris is a full-time attending physician in the Department of Internal Medicine. Mr Rasor is a third-year osteopathic medical student at Midwestern University's Arizona College of Osteopathic Medicine in Glendale; he participates in the Hoop of Learning programs that encourage Native American youth to pursue careers in healthcare. Dr Harris is an associate adjunct professor of clinical medicine at Midwestern University's Arizona College of Osteopathic Medicine in Glendale.

Correspondence to Joseph Rasor, PT, OMS III, Administration, Phoenix Indian Medical Center, 4212 N 16th St, Phoenix, AZ 85016-5319.E-mail: joseph.rasor{at}azwebmail.midwestern.edu

In the United States, many visits to physician offices are for complaints of pain. Patients who have moderate to severe pain can be effectively treated with different modalities, including the use of opioids. Effective management requires that the physicians be open minded and thorough. Physicians should take a complete history and do a complete physical examination, including an osteopathic structural examination, to help develop a comprehensive treatment plan. This plan should include follow-up visits for continued assessment of the treatment plan. A continued reassessment of the treatment plan and the patient's response to the treatment has been shown to be most beneficial to the patient and the physician. Osteopathic physicians using the osteopathic medical model of treatment should identify psychosocial as well as somatic dysfunctions and appropriately treat patients for them. They should not avoid the use of opioids because of fear of patients' becoming addicted, but rather they should integrate the use of opioids in a multidisciplinary treatment plan. Opioids are potent drugs that require monitoring and dosing according to patient response.

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