American Osteopathic Association Adopts Policies on Treatment of Patients in Pain: An Overview
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Dr D'Alonzo, AOA editor in chief, is a professor of medicine, in the division of pulmonary and critical care medicine at Temple University School of Medicine in Philadelphia, Pa. Mrs Stipp is assistant director of publications for JAOA—The Journal of the American Osteopathic Association.
Intractable and Chronic Nonmalignant Pain
The JAOA's four-part series also emphasizes the differences between addiction, substance abuse, chemical dependency, and tolerance. The AOA's revised policy statement recognizes these distinctions by including "patients with chemical dependency and/or substance abuse history" among those to whom a "physician may prescribe or administer controlled substances in the course of the treatment for a diagnosed condition causing intractable and/or chronic nonmalignant pain." This revised policy also recognizes the need for physicians to be hypervigilant in screening these patients for the presence of both drugs of abuse and treatment medication.
Long-Acting Opioid and Opiate Medication
Also in July, the House of Delegates adopted a policy on long-acting opioid/opiate medication (see box on page S31). The policy recognizes the rights of all patients to have access to intervention and treatment modalities that are medically appropriate to achieve safe and effective control of acute and chronic pain.
The policy further states that "it is in the best interest of all patients not to confine, or seek to regulate Opioid/Opiate medications by limiting their use to a small number of selected specialties of medicine." The policy contends that such "exclusionary strategies will limit access for patients with medical indications for therapy, complicate delivery of care, and add to pain and suffering of patients in all areas of our country."
End-of-Life Care
The new position paper encompasses issues related to informing patients and their families when there is no hope of cure, assuring them of providing comfort through hospice and palliative treatment, and engaging patients in discussions and decision making regarding advance planning for end-of-life care.
Footnotes
At its July 2005 meeting, the House of Delegates of the American Osteopathic Association (AOA) approved two new policy statements and amended another that are especially relevant to the editorial goals of the four supplements devoted to pain management that JAOA—The Journal of the American Osteopathic Association published this year.
This continuing medical education publication is supported by an unrestricted educational grant from Purdue Pharma LP
Editor's Note
Readers can find the policy statements on DO-Online (www.doonline.org) by clicking on the link titled "About the AOA" on the home page, followed by the link titled `Position Papers" under the subheading "Ethics and Politics." All position papers are listed alphabetically. The direct link is http://www.doonline.osteotech.org/index.cfmPageID=aoa_position.
References
1. Wyatt SA, Vilensky W, Manlandro JJ, Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. JAm Osteopath Assoc.2005; 105(suppl 3):S18 –S25.
2. Goldstein FJ. Editor's message—Law enforcement campaign: barrier to optimal pain management. J Am Osteopath Assoc. 2005;105(suppl 5):S2 –S4.
3. Rasor J, Harris G. Opioid use for moderate to severe pain. J Am Osteopath Assoc.2005; 105(suppl 3):S2 –S7.
4. American Osteopathic Association End-of-Life Care Commitee. AOA's position against use of placebos for pain management at end of life. JAm Osteopath Assoc.2005; 105(suppl 1):S2 –S5.(Gilbert E. D'Alonzo, Jr, )
Intractable and Chronic Nonmalignant Pain
The JAOA's four-part series also emphasizes the differences between addiction, substance abuse, chemical dependency, and tolerance. The AOA's revised policy statement recognizes these distinctions by including "patients with chemical dependency and/or substance abuse history" among those to whom a "physician may prescribe or administer controlled substances in the course of the treatment for a diagnosed condition causing intractable and/or chronic nonmalignant pain." This revised policy also recognizes the need for physicians to be hypervigilant in screening these patients for the presence of both drugs of abuse and treatment medication.
Long-Acting Opioid and Opiate Medication
Also in July, the House of Delegates adopted a policy on long-acting opioid/opiate medication (see box on page S31). The policy recognizes the rights of all patients to have access to intervention and treatment modalities that are medically appropriate to achieve safe and effective control of acute and chronic pain.
The policy further states that "it is in the best interest of all patients not to confine, or seek to regulate Opioid/Opiate medications by limiting their use to a small number of selected specialties of medicine." The policy contends that such "exclusionary strategies will limit access for patients with medical indications for therapy, complicate delivery of care, and add to pain and suffering of patients in all areas of our country."
End-of-Life Care
The new position paper encompasses issues related to informing patients and their families when there is no hope of cure, assuring them of providing comfort through hospice and palliative treatment, and engaging patients in discussions and decision making regarding advance planning for end-of-life care.
Footnotes
At its July 2005 meeting, the House of Delegates of the American Osteopathic Association (AOA) approved two new policy statements and amended another that are especially relevant to the editorial goals of the four supplements devoted to pain management that JAOA—The Journal of the American Osteopathic Association published this year.
This continuing medical education publication is supported by an unrestricted educational grant from Purdue Pharma LP
Editor's Note
Readers can find the policy statements on DO-Online (www.doonline.org) by clicking on the link titled "About the AOA" on the home page, followed by the link titled `Position Papers" under the subheading "Ethics and Politics." All position papers are listed alphabetically. The direct link is http://www.doonline.osteotech.org/index.cfmPageID=aoa_position.
References
1. Wyatt SA, Vilensky W, Manlandro JJ, Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. JAm Osteopath Assoc.2005; 105(suppl 3):S18 –S25.
2. Goldstein FJ. Editor's message—Law enforcement campaign: barrier to optimal pain management. J Am Osteopath Assoc. 2005;105(suppl 5):S2 –S4.
3. Rasor J, Harris G. Opioid use for moderate to severe pain. J Am Osteopath Assoc.2005; 105(suppl 3):S2 –S7.
4. American Osteopathic Association End-of-Life Care Commitee. AOA's position against use of placebos for pain management at end of life. JAm Osteopath Assoc.2005; 105(suppl 1):S2 –S5.(Gilbert E. D'Alonzo, Jr, )