On the Importance of Using the Right Metrics for Patient Outcomes and Payment: Pain, Pain Interference, and Physical Function – Beth D Darnall, PhD and Mark D Sullivan, MD, PhD – September 2018
I can only access the first few sentences of this article, but it is significant because its authors are two of the people who have championed the drive to reduce opioid prescriptions.
Now they are finally pushing back against the insanity of policies that have arisen in reaction to their vocal opposition to “excessive” opioid prescribing. These policies are focused only on reducing the milligrams of opioids prescribed and nothing else, resulting in mandated opioid dosage reductions in stable patients.
One of the authors, Beth Darnall, recently circulated a petition among medical professionals to reject such crude “solutions” to the “opioid crisis”.
In this installment of the Ethics Forum, we examine the importance of measurement precision and choice of clinical outcome measures.
Physical function has long been known to be an important characteristic of individuals with pain. Indeed, it has noted to be a more important index of treatment response and recovery than pain intensity.
The 2016 Centers for Disease Control’s Guideline for Prescribing Opioids for Chronic Pain states that “clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety”.
This increasing focus on patient function reveals an ethical imperative to examine whether we are measuring the right thing, and in…
The only variable being measured by new policies meant to ameliorate the wrongly named “opioid crisis” is the opioid dose, regardless of patient diagnosis, pain level, or functionality.
Because these two authors have persistently questioned the legitimacy of prescribing opioids for chronic pain, their ideas have been translated into simplistic rules and even legislation to sharply curtail all use of opioids, even in cancer patients and hospice.
The numbers of milligrams identified in the CDC Guideline as requiring more caution are being used as absolute maximums, and all patients, regardless of their medical status, are being forced to taper down to those numbers.
Such punitive actions against legitimate and compliant pain patients seem like either “practicing medicine without a license” or outright malpractice. Forced opioid tapers without consideration of the patient’s medical condition are definitely unethical.
If anyone can get access to the full article, please let me know!