Pain Management: The New Treatment Imperative
Library: MED
Description: JAOA Supplement on Pain Management chronicles multidisciplinary approach to pain management, looks at barriers that prevent proper delivery of opiod analgesia and critical issues surrounding those who care for the dying patient. (J. of the Am. Osteopathic Association, Sep-2002)

Contact: Carol Weisl

Pain Management in the New Millennium

A new day is dawning in the field of pain management. A recently-enacted requirement by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now ensures that patients must receive appropriate pain management in all healthcare settings. Although providing adequate analgesia would seem to be a given for suffering patients, that is not always the case. For Frederick Goldstein, Ph.D., Professor of Clinical Pharmacology, Department of Biomedical Sciences at Philadelphia College of Osteopathic Medicine (PCOM), proper pain management has been a longtime goal. Dr. Goldstein's most recent effort to focus attention on this critical patient issue is to serve as editor of a 24-page supplement to the Journal of the American Osteopathic Association (JAOA) entitled Advances in Pain Management.

This supplement, which accompanies the September 2002 issue of the JAOA, focuses on a variety of approaches to providing comfort for patients in pain including psychological therapies, osteopathic manipulative treatment, barriers among physicians that prevent proper delivery of opioid analgesia, and critical issues surrounding those who care for the dying patient. Several articles, including one written by Dr. Goldstein, focus on pharmacological treatment.

One barrier to managing pain with opioids (e.g., morphine) is a misunderstanding of the differences between addiction and physical dependence. Some clinicians are hesitant to prescribe the quantity of opioids necessary for adequate pain management due to a mistaken belief that the patient will become addicted. "With respect to clinical pharmacology, proper control of pain can be accomplished only when healthcare professionals clearly understand differences between addiction and physical dependence; they are not the same," emphasizes Dr. Goldstein in his opening editorial.

The seven research papers contained in the supplement present evidence that chronic pain can be managed successfully. "Pain has been undertreated and understudied." explains Dr. Goldstein. "People need to know there are solutions." "My colleagues at PCOM and I have been committed to studying approaches to pain management before it was mandated. This current supplement includes our research and other important treatment options as presented by colleagues outside our medical school. It's imperative that we all move forward with our studies, but it is even more essential that healthcare centers put the positive results of our and others clinical research into action and do what we know is possible to manage pain."

Dr. Goldstein is actively involved in research at PCOM and at Einstein Medical Center where he is on staff and conducts research to reduce post-operative pain. Previously, he conducted clinical research at Walter Reed Army Medical Center and the former City Avenue Hospital.

"Events in our past seem to slip further away with time. But what happens when they circle back and meet us head the present? Before we allow ourselves to be consumed by our regrets, we should remember the mistakes we make in life are not so important as the lessons we draw from them.." Outer Limits(Last supper)