A different approach to pain
I read the article “Seeking clarity for opioid prescribing” in the April ACP Internist, and I believe it is time for the medical community to scale back the universal screening for pain promoted by the Veterans Administration and The Joint Commission and implemented through the “Pain as the 5th Vital Sign” campaign. We must bear responsibility for the creation of pain management mills, misguided patient expectations, and skyrocketing narcotic prescribing, abuse, and deaths. Instead, we need intelligent and targeted interventions for acute and chronic pain when warranted.
Physicians need not ask all patients about pain if they are not presenting or asking about pain. Instead, as part of the history and examination, physicians must consider patients' illness, condition, function, and pain if needed. Overzealous efforts must be replaced by research-proven methods to alleviate pain or improve functioning; prescribing narcotics is too often the quick and wrong response. Like insomnia, we cannot vanquish it in a sea of sleeping pills and worsen the problem by creating addiction. The public and country deserve better.
Perry Pong, MD, ACP Member
New York, N.Y.