Pain Complications and Treatment
by Forest A. Tennant, MD, DrPH
 The year 2003 has seen some of the
most revealing insights into the nature of pain and its consequences. Foremost is the
revelation that there are complications that result directly from pain and that are just
now being understood. Ailments, diseases and life threatening conditions — previously
thought of as unrelated to pain generation or the causal effects of pain — are now
understood to also directly result from pain conditions. For example, a patient suffering
from fibromyalgia or any other condition that produces severe, unrelenting, persistent
pain may also develop such adverse consequences as cardiovascular conditions, hormonal
abnormalities, immune suppression, depression or even dementia. The understanding of these
phenomena along with their practical treatment will be the keynote of the Practical Pain
Management 2004 Editorial Calendar.
The profound understanding that severe, persistent pain is a disease unto itself with a
cascade of serious complications compels physicians to rebuff the recent adverse publicity
about celebrities, opioids, and diversion. The publicity represents isolated cases and not
the vast majority of needy patients and caring, competent practitioners. It is poorly
appreciated that the treatment of severe, persistent pain with opioids and other
controlled drugs is now done with a set of standards that are more demanding than
treatment of any other chronic condition. All the professional pain and addiction
organizations plus the National Federation of Medical Boards has adopted a 7-point set of
standards and guidelines which require: (1) history and physical; (2) informed consent;
(3) treatment plan; (4) periodic visits; (5) necessary consultations; (6) complete
records; and (7) compliance with controlled substance regulations. Put another way, our
field has the ultimate in “Quality Assurance.”
It’s time to let all concerned parties know that severe, persistent pain must
sometimes be treated with opioids to avoid misery and early death and, in so doing, pain
treatment physicians have adopted stringent treatment standards to responsibly protect
patient, physician, and society.
Forest A. Tennant, MD, DrPH
Editor in Chief
— Nov/Dec 2003
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