JAOA • Vol 105 • No suppl_5 • November 2005 • 29-31
American Osteopathic Association Adopts Policies on Treatment of Patients in Pain: An Overview
Gilbert E. D'Alonzo, Jr, DO;
Karen Bjorkman Stipp
Dr D'Alonzo, AOA editor in chief, is a professor of medicine, in the
division of pulmonary and critical care medicine at Temple University School
of Medicine in Philadelphia, Pa. Mrs Stipp is assistant director of
publications for JAOA—The Journal of the American Osteopathic
Association.
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Intractable and Chronic Nonmalignant Pain
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In July, the AOA House of Delegates revised the AOA's position on
intractable pain, first adopted in 1997 (see box on pages
S29–S30). This revision reiterates the AOA's position that osteopathic
physicians have a "duty and responsibility to treat patients suffering
from intractable pain and/or chronic nonmalignant pain." The resolution
notes that such pain "may be associated with a long-term incurable or
intractable medical condition or disease." Those are the types of
conditions covered in Part 3 of JAOA's 2005 pain management series
(available at
http://www.jaoa.org/content/vol105/suppl_4/).
In addition, the position statement instructs the AOA to advocate, and
promote to students, residents, fellows and practicing physicians educational
resources regarding addictive disorders, diversion awareness and monitoring,
and appropriate referral resources, as well as prevention and treatment of
pain disorders—a mission that the JAOA's 2005 series of
supplements on pain management is helping to serve. Part 2 in this series, for
example, features an article on medical education in substance
abuse1 (available at
http://www.jaoa.org/cgi/reprint/105/3_suppl/6S).
The JAOA's four-part series also emphasizes the differences
between addiction, substance abuse, chemical dependency, and tolerance. The
AOA's revised policy statement recognizes these distinctions by including
"patients with chemical dependency and/or substance abuse history"
among those to whom a "physician may prescribe or administer controlled
substances in the course of the treatment for a diagnosed condition causing
intractable and/or chronic nonmalignant pain." This revised policy also
recognizes the need for physicians to be hypervigilant in screening these
patients for the presence of both drugs of abuse and treatment
medication.
The policy statement emphasizes that no physician adhering to appropriate
prescribing should be subject to disciplinary action by state medical
licensing boards or criminal prosecution by federal or state government
agencies for administering controlled substances to treat patients for
intractable chronic nonmalignant pain. According to Cato Institute Policy
Analysis No. 545 (available at
http://www.cato.org/pubs/pas/pa545.pdf),
such is not always the case (see the commentary on this policy
analysis by Frederick J. Goldstein, PhD, beginning on page
S22).
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Long-Acting Opioid and Opiate Medication
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Also in July, the House of Delegates adopted a policy on long-acting
opioid/opiate medication (see box on page S31). The policy recognizes
the rights of all patients to have access to intervention and treatment
modalities that are medically appropriate to achieve safe and effective
control of acute and chronic pain.
The policy further states that "it is in the best interest of all
patients not to confine, or seek to regulate Opioid/Opiate medications by
limiting their use to a small number of selected specialties of
medicine." The policy contends that such "exclusionary strategies
will limit access for patients with medical indications for therapy,
complicate delivery of care, and add to pain and suffering of patients in all
areas of our country."
Part 2 in the JAOA's supplement series on pain management
addresses such barriers to pain control for moderate to severe pain as
physicians are reluctant to use opioid to treat
patients.3 The
complete supplement is available at
http://www.jaoa.org/content/vol105/6_suppl_3/.
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End-of-Life Care
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Another new AOA policy brings this supplement series full circle on
end-of-life care. Part 1 of this series featured the AOA's position statement
against the use of placebos in treating patients for pain at the end of
life4 (available at
http://www.jaoa.org/cgi/reprint/105/3_suppl/2S).
Now, Part 4 of this series features the AOA's new policy statement on
end-of-life care (see page S32–S34). Like the statement against
the use of placebos, the new statement was drafted by the AOA End-of-Life Care
Committee.
The new position paper encompasses issues related to informing patients and
their families when there is no hope of cure, assuring them of providing
comfort through hospice and palliative treatment, and engaging patients in
discussions and decision making regarding advance planning for end-of-life
care.
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Footnotes
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At its July 2005 meeting, the House of Delegates of the American
Osteopathic Association (AOA) approved two new policy statements and amended
another that are especially relevant to the editorial goals of the four
supplements devoted to pain management that JAOA—The Journal of the
American Osteopathic Association published this year.
This continuing medical education publication is supported by an
unrestricted educational grant from Purdue Pharma LP
Editor's Note
Readers can find the policy statements on DO-Online
(www.doonline.org)
by clicking on the link titled "About the AOA" on the home page,
followed by the link titled `Position Papers" under the subheading
"Ethics and Politics." All position papers are listed
alphabetically. The direct link is
http://www.doonline.osteotech.org/index.cfm?PageID=aoa_position.
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References
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1. Wyatt SA, Vilensky W, Manlandro JJ, Dekker MA. Medical education in
substance abuse: from student to practicing osteopathic physician.
JAm Osteopath Assoc.2005; 105(suppl 3):S18
–S25.2. Goldstein FJ. Editor's message—Law enforcement campaign:
barrier to optimal pain management. J Am Osteopath
Assoc. 2005;105(suppl 5):S2
–S4.[Abstract/Free Full Text]
3. Rasor J, Harris G. Opioid use for moderate to severe pain.
J Am Osteopath Assoc.2005; 105(suppl 3):S2
–S7.
4. American Osteopathic Association End-of-Life Care Commitee. AOA's
position against use of placebos for pain management at end of life.
JAm Osteopath Assoc.2005; 105(suppl 1):S2
–S5.
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Intractable and Chronic...
Long-Acting Opioid and Opiate...
