Make no mistake — pain is a problem, nationwide and in Southeastern Ohio. The treatment of chronic pain has long posed a challenge for physicians for medical and legal reasons. Barriers to adequate, regular treatment have proved a grievous dilemma that patients with chronic pain have had to bear.

A conference to be held Tuesday, Sept. 26, will address the issues surrounding the treatment of chronic, unremitting pain, specifically treatments using narcotic medication. The Ohio University conference, “The Tragedy of Untreated Pain,” will take place at the Walter Hall Rotunda, and brings together physicians, dentists, pharmacists, nurses, psychologists and other health-care professionals who deal with the treatment of chronic pain. The conference, which takes place during Pain Awareness Month, is sponsored by COM’s Pain & Palliative Care Committee, which was formed to address the difficult issues faced by patients and physicians.

One afternoon, a near avalanche of chronic pain patients confronted a member of that committee — Peter Dane, D.O., OU-COM associate dean for predoctoral medical education — in his practice as an urgent care physician at University Medical Associates in Athens. The experience made him well aware of a local problem needing attention.

For patients, says Dane, the problem of chronic pain needs to be addressed not only for the obvious medical reasons, because of the ramifications of untreated pain, which present a paradox. “People who suffer persistent, unremitting pain are frequently unable to work. If they can’t work, they probably don’t have insurance. If they don’t have insurance or other resources, they can’t afford the myriad of treatments that might be needed for the effective treatment of chronic pain.”

In the past, he says, physicians had to cope with medical governing boards, pharmacy regulatory boards and other oversight bodies with overtly adversarial stances in regards to many physicians’ approaches to treating pain. It appeared to physicians, and their patients, no doubt, that these oversight boards were more concerned with avoiding patient addiction and drug diversion than they were with the optimal treatment of pain. Although it was not those boards’ intention, says Dane, the resulting fear of legal sanctions by these bodies often circumscribed more aggressive approaches to achieving the optimal care of patients. And, of course, sometimes physicians were sanctioned.

It was as recently as about 10 years ago that the Federation of State Medical Boards, a nationwide organization of state medical regulatory boards whose charge is “the continual improvement in the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice” resolved to address the concerns of pain-care providers. The result, says Dane, was an initiative designed to ease the fears of physicians and clarify the positions of these boards in regards to the treatment of chronic pain. What this initiative entailed were policies that promoted more effective treatment of chronic pain, while still avoiding the potential downsides of addiction, diversion and side effects.

“Medical oversight boards still hold physicians to very explicit standards,” says Dane, “but their requirements are what should be expected of physicians for any patient encounter: to keep good medical records that make it clear why a certain treatment regimen — which may include narcotic medication —  has been chosen and to provide responsible oversight of their use.

“That’s simply good medicine,” he says.

Although the adversarial attitudes of boards may be a thing of the past, the fears and reluctance of physicians regarding the treatment of chronic pain endures.

“The committee decided it would be productive to bring representatives from the pharmacy board and the state medical board here to address physicians and care providers candidly and directly as to where they, the oversight boards, stand and to clarify the liabilities and obligations of providers.”

“We want physicians to come to this conference and ask these representatives poignant, pointed questions: ‘If I do this, am I jeopardizing my license?’ ‘If I do this, do I risk being sanctioned?’ ‘What can I do to minimize my liability and still provide optimal care to my patients?’ — and listen to their answers.”

Also at the conference, Ohio’s On-line Prescription Monitoring Program, which is designed to prevent drug abuse and provide current information on patients’ prescription use, will be reviewed.

Co-sponsoring the conference are the college’s Community Health Programs and major pharmaceutical companies.

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