Frequently Asked Questions (FAQ's)

Q. How widespread is the problem of untreated and under-treated pain?
Q. What does pain medicine consist of?
Q. What is the state of pain medicine in Utah?
Q. Where can I get information on the federal regulations that govern controlled substances? For instance, how many refills can be given, can a prescription be authorized over the phone, etc.?
Q. Where do I find information on state controlled-substances laws?
Q. What are the common barriers to effective pain treatment?
Q. How common is addiction to painkillers prescribed for pain?
Q. How do I find the most effective treatment for my pain?
Q. How can doctors find the best pain treatment for their patients?
Q. How do doctors get certified in pain medicine?

Q. How widespread is the problem of untreated and under-treated pain?

• Pain accounts for 80% of all physician visits.
• 64% of pain sufferers will see a doctor only when they cannot stand the pain any longer.
• 42% of people who visit their doctor for pain feel misunderstood by their physician.
• 50 million Americans are partially or totally disabled by chronic pain.
• 22% of chronic pain patients have changed doctors at least three times in their search for pain relief.
• The primary reasons chronic pain patients change physicians is due to doctors':

-Attitude toward patients' pain

-Knowledge about pain

-Ability to treat pain

Source: "Untying the Knot," National Pain Awareness Campaign, founded by the National Pain Foundation and the American Academy of Pain Medicine.

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Q. What does pain medicine consist of?

Pain medicine has three primary components:

• Medical management. Includes the use of analgesics, antidepressants, anticonvulsants and opioids, which are opium-based painkillers.
• Interventional treatments. Includes blocks, intradiscal procedures, spinal cord stimulators and intrathecal delivery systems.
• Physical and behavioral therapies. These address rehabilitation and the emotional contributions to the pain experience.

Some patients will need a combination of approaches to obtain the best pain relief. Because few doctors are experts in all three areas, the referral and consultation process among physicians is an important part of managing patients' pain. Another challenge is to improve insurance coverage for this integrated approach to the treatment of pain. A surprising number of claims for pain treatment are denied by insurance companies.

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Q. What is the state of pain medicine in Utah?

Utah has twice earned a C+ grade (A-F rating scale) in an assessment of state pain policies by the Pain & Policy Studies Group at the University of Wisconsin. Visit our Pursuit of Excellence section to learn more.

Guidelines : In 1998, the Federation of State Medical Boards (FSMB) adopted the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain as a guide for state medical boards. By 2003, 22 states, including Utah, had adopted policies using all or part of the model guidelines (including Utah in 1999). Click here to read the guidelines: http://www.medsch.wisc.edu/ painpolicy/domestic/utmbguid2.htm

In 1992, the Utah Division of Occupational and Professional Licensing adopted a position paper called "Prescribing Controlled Substances for Cancer Pain." Read it here:

http://www.medsch.wisc.edu/painpolicy/domes tic/utmbguid.htm

Read news from the Utah Division of Occupational and Professional Licensing: http://www.dopl.utah.gov/news.htm

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Q. Where can I get information on the federal regulations that govern controlled substances? For instance, how many refills can be given, can a prescription be authorized over the phone, etc.?

A. Here is a link to the federal Controlled Substances Act (CSA): http://www.deadiversion.usdoj.gov/21cfr/21usc/21ibusct.htm

Click on the following link to read about controlled substance schedules and lists: http://www.deadiversion.usdoj.gov/schedules/schedules.htm

The CSA contains a section called "Prescriptions," which details the rules for each schedule: http://www.deadiversion.usdoj.gov/21cfr/21usc/829.htm

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Q. Where do I find information on state controlled-substances laws?

See the Utah statute, the Uniform Controlled Substances Act:. http://www.le.state.ut.us/~code/TITLE58/58_13.htm

The following link contains rules written by The Utah Division of Occupational and Professional Licensing. The page includes licensing information, rules for prescribing and rules for accessing the state prescription database. http://www.rules.utah.gov/publicat/code/r156/r156-37.htm

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Q. What are the common barriers to effective pain treatment?

Perhaps the single greatest barrier to the availability of pain relief is fear among doctors of regulatory or legal action against them connected with the prescribing of opioids. Doctors, themselves, sometimes stigmatize the use of opioids and mislabel pain patients as addicts. Encouragingly, enforcers, whose job it is to stop drugs from being diverted for illegal sale or use, also recognize the potential harm to society of hindering the availability of painkillers for legitimate pain patients.

In 2001, the U.S. Drug Enforcement Administration joined with 21 major health organizations to call for a balanced approach to keeping prescription drugs available for medical purposes while battling their diversion. Read the press release here:

http://www.deadiversion.usdoj.gov/pubs/pressrel/newsrel_102301.pdf

Read "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel," in cooperation with the U.S. Drug Enforcement Administration, Last Acts Partnership and the Pain & Policy Studies Group, University of Wisconsin.

The DEA has removed this document from its Web site citing legal misstatements.
Please click here for more information.

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Q. How common is addiction to painkillers prescribed for pain?

The prevalence of drug abuse and addiction in patients prescribed narcotic medications for pain is not conclusively known. However, most research indicates addiction rates are similar to those in the general population. Other research shows a somewhat greater incidence of drug abuse among pain patients.

The screening of patients for certain risk factors such as a history of substance abuse appears useful in predicting whether or not a patient is likely to abuse. Patients with histories of substance abuse deserve treatment for pain but must be carefully monitored to ensure compliance with treatment.

It is also important to understand the differences between frequently confused terms such as drug abuse (intentional misuse), addiction, tolerance and physical dependence. A person who is physically dependent on a drug, for example, may experience symptoms of withdrawal if the drug is suddenly stopped. Such symptoms do not, in themselves, indicate addictive disease. Similarly, a person who aggressively demands more medication may be suffering from under-treated pain, not addiction.

Visit www.ampainsoc.org/advocacy/opioids.htm to read "The Use of Opioids for Chronic Pain," a consensus statement from the American Academy of Pain Medicine and the American Pain Society.

Visit www.ampainsoc.org/advocacy/opioids2.htm to read the consensus document from the AAPM, American Pain Society and American Society of Addiction Medicine regarding the differences between physical dependence, tolerance and addiction.

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Q. How do I find the most effective treatment for my pain?

Patients should question their family doctors on their attitudes toward pain treatment and, when appropriate, seek referrals. Medical professionals should realize that pain treatment is not synonymous with the prescribing of narcotic painkillers. A number of very effective non-pharmacological options are available. However, if painkillers are indeed the best treatment, doctors should not allow misguided fears to interfere with appropriate treatment.

Visit www.NationalPainFoundation.org for more information about available treatment options.

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Q. How can doctors find the best pain treatment for their patients?

Doctors, when appropriate, should consult with specialists in a variety of fields related to pain and help patients find the best treatment through referrals or other arrangements. It is noteworthy that some pain specialists are focused on particular areas of interest. It is important to find the right expert for the job. Once a referral physician is located, a cover letter is the best method for introducing the patient. A letter is helpful because it gives the pain specialist the information needed to decide whether another colleague would be more suitable.

Visit www.NationalPai nFoundation.org for more information about available treatment options.

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Q. How do doctors get certified in pain medicine?

Through the American Board of Pain Medicine, which offers the certification exam. For more information, call 847-375-4726 or visit www. abpm.org. Approximately 1,500 pain medicine physicians are board certified.

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