Florida's official policy on chronic pain-- vital reading

[Guest guest]

How is it that the State of Florida can come up with progressive guidelines

for chronic treatment, while the same is ignored virtually everywhere else?

This will give you a sense of how you should be entitled to be treated. I

would even suggest making a copy for *some* doctors. And this is not brand

new, it has been in place for a while.

Ken

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Florida Pain Management Guidelines Courtesy Pain-L

Discussion Group

A Landmark message to Florida doctors from the State brings

new hope to Chronic Pain Patients. If every State did this,

the War Against Pain Patients, would soon be over, and tens

of thousands of American lives would be saved annually. From

Florida’s new guidelines with American Society for Action on

Pain, Striving for Adequate Pain Medication emphasis added.

FLORIDA GENERIC CLINICAL PRACTICE GUIDELINES The State of

Florida recognizes that pain, including intractable pain, is

often under treated. Unrelieved pain can have harsh and

sometimes disastrous influence on the quality of life for

patients and their families.

PAIN MANAGEMENT SHOULD BE A HIGH PRIORITY IN FLORIDA

Principles of quality medical practice dictate that citizens

of Florida who suffer from pain should seek relief with

treatment that is currently available. The appropriate

application of current knowledge and treatments can greatly

improve the quality of life for many Florida citizens and

reduce the morbidity and costs associated with untreated

pain.

In addition to promoting competent patient care, these

guidelines are intended to help physicians avoid

investigation if controlled substances are appropriately

prescribed for short or long term pain management.

PRESCRIBING DANGEROUS DRUGS AND CONTROLLED SUBSTANCES FOR

PAIN The proper treatment for any patient’s pain depends

upon a careful diagnosis of the etiology of the pain,

selection of appropriate and cost effective treatments and

the ongoing evaluations of the results of treatment.

Patients with chronic pain may demand more time of the

practitioner because of the complexity of their problem.

Opioid analgesics and other dangerous and controlled

substances are useful for pain treatment. They are the

cornerstone of treatment for acute pain due to trauma or

surgery and of chronic pain due to progressive diseases,

such as cancer. Other than that specified in the Physicians

Desk Reference (PDR), large doses, if documented, may be

necessary to control severe pain. Extended therapy may also

be needed to alleviate chronic pain. Published formularies,

relating to commercial financial incentives, should not be a

deterrent to achieving optimal pain relief.

Opioid analgesics may also be useful in treating patients

with intractable nonmalignant pain especially when efforts

to remove or treat the pain with other modalities have

failed. Such intractable pain may have a number of different

etiologies and might require several treatment methods. In

addition, the extent to which pain is associated with

physical and psychosocial impairment varies greatly.

Therefore, when patients are selected for therapy trials

using dangerous drugs and opioid therapy, care should be

used to assess the pain as well as the patient’s disability.

The duration of drug therapy should depend on the physician’s

evaluation of the results of treatment, including the degree

of pain relief, the changes in physical and psychological

functioning and the appropriate utilization of health care

resources.

Addiction in relation to these substances should be placed

in proper perspective. Physical dependence and tolerance are

normal physiological consequences of extended opioid therapy

and are not the same as addiction.

Addiction is a behavioral syndrome characterized by

psychological dependence and aberrant, drug-related

behaviors. Addicts use drugs in a compulsive manner and not

for medical purposes. An addict may also be physically

dependent or tolerant. Patients with chronic pain shouldn’t

be considered addicts merely because they are being treated

with opioids. Physicians need to be cognizant of the fact

that patients with a history of drug abuse may be

particularly problematic to the management of pain.

PAIN MANAGEMENT, CONTROLLED SUBSTANCES AND THE LAW Federal

government laws and regulations and those of the State of

Florida impose special requirements for dangerous drugs and

controlled substances prescription. These regulations are

aimed at preventing harm to the consumer from dangerous

prescription drugs which are diverted to nonmedical uses. It

is legitimate medical practice for physicians to prescribe

controlled substances for the treatment of pain, including

intractable pain.

The Agency for Health Administration supports the

examination must be based on the documented diagnosis and

treatment rather than on the dosage or the number of

prescriptions written. Concerns about regulatory scrutiny

should not cause physicians to be reluctant to prescribe or

administer dangerous and controlled substances, including

Schedules II-V drugs as provided for in Florida Statutes

s.893.03, for patients with legitimate medical needs.

Physicians need not fear administrative action when

prescribing dangerous drugs and controlled substances to

patients in their care for a pathology or condition when the

prescription is issued after a good faith examination and

there is medical indication for the prescription.

(ASAP Editor’s Note: Please keep in mind that Ankylosing

Spondylitis, doesn’t show up on X-ray film for up to 14

years after the excruciating disease begins. There is no

diagnostic “proof” that the patient should be having pain,

when in fact, the patient is having excruciating pain.

Doctors should ALWAYS suspect Ankylosing Spondylitis, when

no other “cause of pain” can be found. It took me 12 years

to get an exact diagnosis, and 13 years before “proof”

started to show up on film!)

The regulatory boards may identify a pattern of dangerous

and controlled substance use which merits further

examination, but private, courteous and professional inquiry

can usually determine whether the physician is appropriately

prescribing for patients in good faith or whether an

investigation is warranted. The Florida Board of Medicine

and the Florida Board of Osteopathic Medicine must judge the

prescription validity relative to the physician’s documented

diagnosis and treatment and if the prescribed drugs are

appropriate for the patient’s condition. Predetermined

limits should not be placed on dosages or length of drug

therapy.

It is the goal of the Agency for Health Care Administration

to CHANGE practitioner perception of regulatory scrutiny and

recognize the commitment of regulatory boards to improving

pain management in order to enhance the quality of lives of

pain-affected patients in Florida. Federal and State laws

and regulatory policies should not hamper the appropriate

use of dangerous drugs and controlled substances for the

relief of pain.

The “orders” from the Florida Agency for Health Care

Administration, goes on for 3 or 4 more pages, all good news

for Chronic Pain Patients, who have faced nightmares in

other States such as Virginia. It appears they are

recommending, that doctors treat Chronic Pain, the very way

that Dr. Hurwitz has been treating it for years! It

is ironic that it took the “over reaction” of the Virginia

Medical Board, to bring this crisis to an end! -- Skip Baker

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