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Aug 6 2013

Get engaged: Board seeks licensee input as part of chronic pain position statement review

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The Federation of State Medical Boards (FSMB) recently adopted a completely revised “Model Policy on the Appropriate Use of Opioid Analgesics in the Treatment of Chronic Pain.” State medical boards are not obligated to accept an FSMB model policy as their own policy, but they are invited and encouraged to use the policy as a basic framework that may be customized to the particular needs of the individual regulatory boards and their licensees. The NCMB used the Federation’s 2004 policy on the treatment of chronic pain as a guide when revising its own position statement on the use of controlled substances for the treatment of chronic pain in 2005. The NCMB is beginning the process of reviewing and revising the 2005 version of its policy soon and expects to use the Federation’s new model policy as a blueprint once again.

The Board also wants to know what you, its licensees, think. If you prescribe controlled substances to treat chronic pain in your practice, or if there is a chance you might start doing so in the future, please take the time to look over the Board’s existing position statement. There have been important developments related to the treatment of chronic pain in the last several years and the Board expects to make significant changes to the position statement.

The Board will hold a public forum to receive comments from interested parties, orally and/or in writing on August 21 from 4-6 p.m. at the Board’s administrative offices in Raleigh.

To help licensees get up to speed on this important issue, we are publishing the full text of the Board’s existing “Policy for the use of controlled substances for the treatment of pain,” as well as an excerpt from the FSMB’s proposed model policy that provides a summary of topics covered. We hope you will take advantage of this opportunity to communicate your thoughts and concerns to the Board. What subjects should be addressed in the Board’s new position? What specific areas related to the use of controlled substances for the treatment of chronic pain would you like Board guidance on?

Licensees may submit comments in writing in advance of the public hearing by emailing them to

Board position statement
Policy for the use of controlled substances for the treatment of pain

Federation of State Medical Boards
Model policy on the appropriate use of opioid analgesics in the treatment of chronic pain

 Comments on this article:

There is no, that is no evidence that long term opioid management provides relief, improved function, improved quality of life or return to work for patients suffering chronic pain. This in spite of 20 years of “pushing” these dangerous medications by the pharmaceutical companies who seem to have attempted to get every person (with pain) in America addicted.

An excellent article by Erikson in the 2006 edition of Pain reviews 10,000 patients in Denmark and concludes that NONE of the goals of opioid use for chronic pain are being met, and calls for further research.

There has been none as far as can tell which would pit non-opioid treatment, (NSAID, exercise, PT, amitriptyline, gabapentin or even acetaminophen) to opioid for say, longer than 6 months.

We have walked more or less blindly into being led to think that “opioids are safer than NSAIDs”, that “there is no ceiling effect” that “we undertreat pain in America” which are all ridiculous statements promulgated by the Pharma industry to get doctors to quit thinking these drugs are addicting or dangerous.

It’s the story of Valium all over again. Nobody uses diazepam to attempt to treat chronic anxiety any more - it’s now clearly understood that long term treatment with diazepam makes anxiety worse. So it is with opioid, hyperalgesia with chronic “exposure” to opioids has been demonstrated first in rats, subsequently in humans. This means that pain may become worse over time with opioid use.

I have been board certified in the area of pain medicine since 1994 and I am watching the pendulum slowly swing back to the idea that these drugs are dangerous and should be used with caution, and close monitoring. It is refreshing to see the Medical board increase its vigilance in order to reduce the death rate, and even more significant, the morbidity associated with the medications.

By Allan Zacher, MD on Aug 10, 2013 at 5:19pm
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