On 2014 Feb 14, David Keller commented:

Clarification: I fully agree with the authors that research is needed to develop better options for treating patients for chronic pain. Physicians should be vigilant regarding persons who lie or feign pain symptoms in order to obtain opioids for illegal purposes. Physicians who violate the law by knowingly prescribing opioids for resale or abuse are criminals and should be prosecuted.

On 2014 Feb 14, David Keller commented:

In response to the editorial “Opioids for Chronic Pain”:

1) The authors distinguish between patients with chronic pain, and patients whose painful condition has a “clear end point of cure or death” (e.g. cancer). They propose restricting or denying opioid prescriptions for chronic pain patients. I disagree. If a patient with severe chronic pain might obtain some relief from opioid therapy, it is wrong to deny the patient that choice.

2) The authors argue that opioids only reduced pain scores by approximately 30% in clinical trials. Why not let the patient decide whether a 30% reduction in pain is worth the side effects and risks of opioid therapy? The degree of pain reduction is subjective and varies between individuals.

3) Overdose deaths caused by opioid abuse are tragic, and we need to work harder to prevent them. At the same time, we are obligated to relieve suffering, and if opioids are required, then they should be an option. Doctors need to educate patients on the safe use of opioids, as with other drugs which can cause overdose deaths (e.g. warfarin, insulin). If a patient requires escalating doses of opioids, or if their physician is uncomfortable about their treatment for any reason, they should be referred to a pain specialist.

4) The authors argue that government regulations make it too burdensome for physicians to prescribe strong opioids, which require monthly visits and non-refillable scripts. We should work to reform those regulations, not use them as an excuse to under-treat pain patients.

5) The authors advocate trying NSAID's, anti-depressants, and physical therapy before prescribing opioids. However, some patients are in too much pain to tolerate physical therapy. Depression caused by unrelenting physical pain may not remit until the pain is treated. And NSAID's can worsen hypertension, coronary disease, renal insufficiency, peptic ulcer disease and congestive heart failure. Opioids can often be prescribed safely in these conditions when NSAID's cannot. Adjunctive treatments should supplement opioids which are required for severe pain, with the goal of tapering the opioids as tolerated.

It is true that physicians need to exercise greater care when prescribing strong opioids, but to deny or restrict opioids for chronic pain patients is not humane or sensible.

To facilitate discussion, I respectfully request the person who found this comment "not helpful" to state their reason

On 2014 Feb 14, David Keller commented:

In response to the editorial “Opioids for Chronic Pain”:

1) The authors distinguish between patients with chronic pain, and patients whose painful condition has a “clear end point of cure or death” (e.g. cancer). They propose restricting or denying opioid prescriptions for chronic pain patients. I disagree. If a patient with severe chronic pain might obtain some relief from opioid therapy, it is wrong to deny the patient that choice.

2) The authors argue that opioids only reduced pain scores by approximately 30% in clinical trials. Why not let the patient decide whether a 30% reduction in pain is worth the side effects and risks of opioid therapy? The degree of pain reduction is subjective and varies between individuals.

3) Overdose deaths caused by opioid abuse are tragic, and we need to work harder to prevent them. At the same time, we are obligated to relieve suffering, and if opioids are required, then they should be an option. Doctors need to educate patients on the safe use of opioids, as with other drugs which can cause overdose deaths (e.g. warfarin, insulin). If a patient requires escalating doses of opioids, or if their physician is uncomfortable about their treatment for any reason, they should be referred to a pain specialist.

4) The authors argue that government regulations make it too burdensome for physicians to prescribe strong opioids, which require monthly visits and non-refillable scripts. We should work to reform those regulations, not use them as an excuse to under-treat pain patients.

5) The authors advocate trying NSAID's, anti-depressants, and physical therapy before prescribing opioids. However, some patients are in too much pain to tolerate physical therapy. Depression caused by unrelenting physical pain may not remit until the pain is treated. And NSAID's can worsen hypertension, coronary disease, renal insufficiency, peptic ulcer disease and congestive heart failure. Opioids can often be prescribed safely in these conditions when NSAID's cannot. Adjunctive treatments should supplement opioids which are required for severe pain, with the goal of tapering the opioids as tolerated.

It is true that physicians need to exercise greater care when prescribing strong opioids, but to deny or restrict opioids for chronic pain patients is not humane or sensible.

To facilitate discussion, I respectfully request the person who found this comment "not helpful" to state their reason