Painstaking decisions: Finding the correct treatment balance

Prescribing either too little or too much pain medication can spell professional disaster.

By Andis Robeznieks, AMNews staff. Sept. 23/30, 2002.

The Oregon Board of Medical Examiners intends to take disciplinary action against one of the state's physicians for improperly treating the pain of two patients.

It's the second time the board has gone after Paul A. Bilder, MD. In 1999, it became the first state medical board to discipline a doctor for undertreating pain when it disciplined the Roseburg pulmonologist on charges of undertreating six patients.

On the other side of the country -- and the other side of the coin -- William Hurwitz, MD, a McLean, Va., internist, is being investigated by a federal grand jury looking into whether the prescriptions he wrote for OxyContin to treat pain constitute drug trafficking. The stories of Dr. Bilder and Dr. Hurwitz, while extreme, highlight the problems physicians face as they try to treat patients without prescribing too much or too little pain medication.

But physicians cannot let the fear of board discipline or criminal charges lead them to shy away from pain treatment. The American Pain Society calculated that untreated pain costs American businesses some $50 billion a year in replacement labor costs for the 20 million people who miss up to 20 days of work each year due to pain.

Doctors are truly between a rock and a hard place, says one expert -- partly because law enforcement authorities don't always understand the principles of pain management, and sometimes because doctors create their own problems by not properly following those principles.

L. Jean Dunegan, MD, who has a pain-management practice at the Hillsdale Community Health Center in Jonesville, Mich., gives a presentation she calls "The Clash of the Titans: Mandated Pain Management vs. the War on Drugs." [...]

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