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Well written, concise statement on chronic pain treatment that does not tip-toe around the realities of abuse, diversion, co-morbid psych disorders.  Far too many of these patients get put on these meds inappropriately, leading to years of problems.

By wfnagel on Apr 28, 2011 at 3:20pm

I think that NCMB should work with the SBI and local law enforcement to determine a HIPPA acceptable process to report suspected doctor shoppers and/or diverters.  We are currently having a difficult time with this at our insitution.

By Edward LaMay on Apr 28, 2011 at 3:45pm

Frankly, this epistle ignores the 1000 lb. guerilla in the room - these chronic pain patients eventually all are narcotic addicts, requiring more and more medication to keep them going.  One aspect of addiction, which is almost universal, is a complete lack of insight on the part of the patient as to their addiction.  There is nothing in this missive which would make me want to do anything but minimize my involvement with prescribing controlled drugs, which as an orthopaedic spine surgeon is part of my lot in life.

By S. Michael T. Tooke on Apr 28, 2011 at 7:42pm

Excellent article. Could you comment on the following: how do you advise patients about the use of lock boxes for their controlled substances? Where can they get them? Do you insist upon their use and how do you verify?

By Harriett Burns on Apr 28, 2011 at 9:17pm

Excellent summary!  The examples were particularly helpful.  Thanks!

By Charles Lapp, MD on Apr 29, 2011 at 10:31am

I like the article.  What do you consider as “high” daily doses of opioids?  When would be the best time to refer to a pain specialist?

By acuriale on May 05, 2011 at 10:25pm