Letter to the Editor: Re: the Health & Wellness article “What Are the Options for Treating Pain?” in the September issue of Pharmacy Times®: 

In this article, the author declares that “Opioids relieve mild to moderate pain but have been proven less effective than OTC ibuprofen for most types of pain, with the exception of cancer.”

From interactions with thousands of patients both in pain management practice (Dr Trescot) and online patient support groups (Dr Lawhern), we know this assertion to be deeply contradicted by reality. For millions of people with a wide range of underlying medical disorders, opioids are the only available therapy that adequately manages pain.

Opioids are associated with significant side effects in some patients, side effects that can frequently be managed by ancillary therapies. Likewise, genetic polymorphism in liver enzymes governing metabolism creates a wide range of minimum effective dose levels between individuals. Higher levels of pain observed in some trials comparing opioids and [nonsteroidal anti-inflammatory drugs] may plausibly be attributed to undertreatment of pain by physicians afraid of sanctions for overprescription, a fear that this article actively promotes.

It is time to acknowledge that opioid pain relievers are a central and indispensable element of pain management practice. They will remain so for years to come.

Richard A. Lawhern, PhD

Director of ResearchAlliance for the Treatment of Intractable Pain

Andrea Trescot, MD

Interventional Pain PhysicianDirectorPain and Headache Centers

Response from the article's author, Monique Miller, PharmD candidate at the University of Connecticut in Storrs:

Drs Lawhern and Trescot are correct that many patients with chronic pain need opioids. Although I noted that these findings cover “most types of pain” and exempted cancer, perhaps I could have been clearer. In the climate in which we now practice, people are looking for effective alternatives to opioids to manage their pain. This article’s goal was to offer alternatives to health care providers and present findings from the National Safety Council’s recent report. We expect to see more studies that identify alternatives to opioids for acute and some types of chronic pain. Responsible prescribers and pharmacists are looking for good evidence that offers alternatives when patients are in pain. As Drs Lawhern and Trescot also point out, responsible prescribers and pharmacists understand that some patients need opioids for their chronic pain and will prescribe them appropriately.

Monique Miller

PharmD CandidateUniversity of Connecticut, Storrs