Question 16: How can a pain specialist overcome patient resistances attributable to the overwhelming amount of negative information being given to the general public?

Raymond Sinatra, MD: Jean, here's a troubling comment. "I'm finding a large group of physicians that are running scared from OxyContin due to all the publicity on the radio. How can a pain specialist overcome the overwhelming information being given to the ... negative information being given to the general public?" One of the problems to preface this, is that patients and their families are ... who truly have pain are refusing to take the patient ... to take the drug. And now their pain is becoming uncontrollable again. What's the answer to these dilemmas?

L. Jean Dunegan, MD, JD, FCLM: You're right, I mean it's a tragedy that the explosion in the news media has now caused not only patients to run scared, but also many physicians to run scared. And you know, we're all out there trying our best to continue to educate and emphasize the management of pain.

Now understand that every physician who is running scared from OxyContin is still presumably treating pain in some fashion. And that means that they are then drawing on presumably short acting opioid medications. And whereas I try to stress the fact that whether as a physician one chooses short or long acting opioid, the philosophy behind around the clock pain management should always be to avoid the peaks and troughs in pain opioid medication.

So you see, if you choose the short acting you're still treating pain, you're still giving people drugs that are potentially dangerous to them. It is a matter of documenting what we do and giving people a rational education to pain management. We have to stop this idea that for one to say they're having pain means they're a wimp, means they're weak, means they don't fit the profile of getting respect from us as physicians. We have to begin to say I'm going to treat you for your pain, this is what I'm going to choose to use for you. But if you choose not to use long acting opioids for around the clock pain and in fact you have someone who needs opioids, even if you choose short acting opioids you should be telling that patient how to take their medication, striving to get a level of opioid that stays relatively constant and just above their threshold for pain.

So you see, we have the danger either way, it's just a matter of documenting that we're doing something rational for the patient. Don't run from a product that you know how to use if it fits the actual illness, that is the pain, that you're trying to treat.