Publisher's Message
by Marvin Rosenfeld, Publisher
 It is the policy of this
publication to advocate complementary and alternative approaches to pain management. Our
medical advisors are finding ways to combine electromedicine, laser therapy, nutrition,
and other approaches with pharmaceutical prescribing, particularly opioids.
It is obvious that for the chronic and intractable patients it starts with opioids but
we are living in an era where this most important approach is under attack. More and more
we are seeing physicians shying away from prescribing opioids. They have seen colleagues
indicted, losing licenses and suffering suspensions. Therefore, as a source of practical
information useful to practicing physicians, we have decided to collect and distribute
information that will lessen the risk in alleviating pain through opioids.
We started by consulting Dr. Forest Tennant, arguably the most active intractable pain
physician in the country. We asked Dr. Tennant to start with something that he feels would
reduce the risk of opioid prescribing. His response follows:
“Over the past two decades, scientists have identified and characterized a liver
enzyme system known as Cytochrome P450. This system metabolizes most drugs including
opioids which are the medical backbone of pain treatment. Approximately 10 million persons
in America now take an opioid drug on a regular basis. The emergence of wide-spread opioid
use has brought about many questions and concerns: necessity for high doses, expense, and
overdose deaths. It turns out that the Cytochrome P450 enzyme system is involved in all
aspects of opioid prescribing. There are genetic deficiencies that may exist in 20% to 30%
of pain patients that may cause inadequate metabolism. These deficiencies may require high
opioid doses or unusual treatment regimens. A failure to recognize a genetic metabolic
defect may lead to overdose and death.”
I’ve asked Dr. Tennant to sort it all out and give us some practical,
easy-to-follow guidelines, such as when to do enzyme testing. This review will be the
feature of our May issue. Dr. Tennant has fore-warned that physicians who prescribe
opioids must now have a fundamental understanding of genetic opioid metabolism
deficiencies as they are now part and parcel of medico-legal issues and the high cost
regimens of some opioid patients.
—Marvin Rosenfeld, Publisher
— April 2010
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