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Saturday, May 15, 1999

New rules for pain relief

Change in guidelines `liberates' doctors to treat suffering patients

By SHAUNE MacKINLAY -- The Daily News

Fearing professional liability if patients become addicts, some Nova Scotia doctors are reluctant to prescribe adequate drugs for pain, says their professional body.

To help solve what it sees as an under-prescribing problem, the Nova Scotia College of Physicians and Surgeons is sending doctors new pain-treatment guidelines.

"It liberates us to properly treat our patients, which in the past we probably haven't done for various reasons, not the least of which is concern about a complaint coming in," said Dr. William Acker, a Halifax family physician and past-president of the college.

The college learned there was a problem when it received a letter from the head of the pain-management centre at Halifax's QEII Health Sciences Centre.

"We know definitely of physicians who just have said, `I've just decided to tear up my narcotics triplicate pad because it's too much hassle,'" said college registrar Dr. Cameron Little yesterday.

Doctors worry their patients might become addicts and the drugs they prescribe will end up on the street, Little said, when there's little evidence people in serious pain, who are treated with narcotics, end up abusing them.

Ian Beauprie, a doctor at the pain-management clinic, welcomed the guidelines. For some patients, he said, narcotics are the best treatment.

"There is a group that go on to have lasting relief with narcotics, with opioids, and function well, and don't increase their doses, and aren't selling it on the street corner, and can achieve a very meaningful life with chronic narcotic therapy," he said.

The guidelines urge doctors to carefully evaluate the patient's current health and medical history, devise a written treatment plan, and get informed consent to treatment.

If the doctor feels the patient is a high risk for abuse, a contract can be drawn up, outlining the frequency of refills and a schedule for blood or urine screening. Doctors are also urged to consult with colleagues when necessary and keep detailed patient records.

With a 14-month wait to see a doctor at the pain clinic, Beauprie said plenty of patients aren't getting the drugs they need from family doctors.

"I think giving them guidelines will give general practitioners a better idea of when it's a right time to introduce narcotics or opioids into a patient's mixture of treatment," he said.

When doctors take proper precautions, they have nothing to fear, Little said. "As long as there's reasons and documentations and what not, you don't have to worry about that, we're not going to be running after you."


Pain Awareness in Nova Scotia [P.A.I.N.S.]
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