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From the Phoenix Indian Medical Center, Indian Health Service, United States Public Health Service, where Mr Rasor is a volunteer. Mr Rasor is a fourth-year osteopathic medical student at Midwestern University/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 in private practice in Sun City, Ariz, where he is an attending physician at the Walter O'Boswell Memorial Hospital, where he specializes in outpatient opiate addiction.

Correspondence to Joseph Rasor, PT, OMS IV, Administration, Phoenix Indian Medical Center, 4212 N 16th St, Phoenix, AZ 85016-5319. E-mail: joe.rasor{at}cox.net

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 opioids. Proper management requires that physicians be open-minded and thorough. Physicians should take a complete history and perform a complete physical evaluation including an osteopathic structural examination to develop a comprehensive treatment plan. This strategy should include follow-up visits for continued assessment of therapy. Continued reassessment of treatment and patient responsiveness have been shown to be most beneficial to both physician and patient. Using the osteopathic medical model of treatment, physicians should identify psychosocial as well as somatic dysfunctions and appropriately treat patients for them. They should not avoid prescribing opioids because of fear of a patient's becoming addicted, but instead, integrate the use of such important analgesics in a multidisciplinary treatment plan. However, it must be recognized that opioids are powerful medications that require monitoring and dosing according to patient response.