It is Time to Move Past Maslow's Hammer in Pain Management
Abraham Maslow first published the famous proverb “if all you have is a hammer, then everything looks like a nail,” in 1966 in The Psychology of…
My Turn, Denver Post, Opinion Editorial Page, December 15, 2016
By Phillip E. Essay, MD
Re: “Opioid rules hinder treatment,” Dec. 10 editorial.
"Colorado’s policy for prescribing and dispensing opioids — authored by the Colorado Dental Board, Medical Board, Board of Nursing, and Board of Pharmacy, in collaboration with the Nurse-Physician Advisory Task Force for Colorado Healthcare — is a responsible and extremely well-written set of guidelines for prescribers and dispensers of one of the most clinically and socially impactful classes of medications in existence.
"These and similar guidelines from the Centers for Disease Control and Prevention do not mandate a standard of care, nor do they encourage the denial of these medications when treating physicians deem them appropriate. The documents are only a rational guideline and are assuredly not the cause for any chronic pain sufferer’s perception of a doctor’s unwillingness to prescribe opioids to treat chronic pain.
"Rather, medical professionals are wisely beginning to apply measurement, evidence and science to the disease of chronic pain much like what is done with diabetes, hypertension and cancer. Physicians are realizing that it is inadequate and at times irresponsible to solely rely on patients’ self-reports of relief. Opioids are no longer viewed as a good alternative to other pain management treatment options. Opioids are very effective in relieving pain, just not all types of pain. In fact, to date, there are no studies that indicate that opioids are effective at all for chronic, benign (non-cancer or nonterminal) pain.
"Physicians and policy makers have the responsibility to strive to balance benefit and risk not only for the individual but also for society. One unspoken risk is that opioids heighten pain more often than was once believed and can render more meaningful, non-opioid treatments for pain ineffective. Their use for treating chronic pain is attractive because they require no effort on the part of the pain sufferer. However, a passive treatment plan stifles the human body’s own pain-relieving mechanisms and can create unrealistic pain management expectations for patients and their families.
"The risks of injudicious prescribing of opioids to society are staggering, much more staggering than the misleading 2015 statistic of 5.8 Colorado deaths due to opioids for every 100,000 residents. With 5.4 million people living in Colorado, the true death due to opioids rate in 2014 was 326 lives lost. The true death due to opioids rate in 2015 was 310. That is an improvement of 16 lives saved in Colorado due to more thoughtful prescribing. That seems like a worthy, admirable and, quite frankly, incredible improvement."
Phillip E. Essay, M.D., is board certified in pain medicine and anesthesiology. He lives in Lincoln, Neb.