What Is Adequate and Appropriate Pain Treatment?-Reply

C. Stratton Hill Jr, MD
JAMA. 1996;275(17):1311. doi:10.1001/jama.1996.03530410024019.
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In Reply.  —These letters focus on many unresolved pain treatment issues that are barriers to establishing a universally acceptable standard of practice for pain treatment. One group of issues is related to education: failure to teach physicians proper opioid prescribing practices resulting in indiscriminantly prescribing them, usually for pain of nonmalignant origin; not teaching physicians that some pain responds poorly to opioids; failure to teach how to assess the patient's subjective report of pain; and not teaching a full range of nondrug modalities for pain. Another group of issues relates to opioid use in our society: how does one distinguish between the legitimate use for medical purposes and the abuse and diversion of legal drugs to illegal use, and if and when is a physician at risk for addicting a patient to these drugs? The final 2 issues deal with the importance of the physician-patient relationship, and the influence of


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