Notice to the Prescription "Managers"

NOTICE ON STANDARD OF CARE INQUIRIES
August 20, 2009

The receipt of a number of inquiries from prescription "management" organizations (Medco most prominently) in the last four months would seem to indicate that there is a recent onset of a notable lack of current knowledge about the contemporary standard of care for Intractable Pain. I am writing now to direct Blue Cross, United Health Care, Aetna, Humana and other insurers to the Clinical Guidelines for the Use of Chronic Opioid Therapy in Non-cancer Pain issued by the American Pain Society in February of 2009.

The pain management of all my chronic pain patients conforms to the Clinical Guidelines for the Use of Chronic Opioid Therapy in Non-cancer Pain issued by the American Pain Society in February of 2009. The opioid treatment regimens of all my chronic patients are developed through careful titration and clinical trial. As with any pharmacological treatment, appropriate pain medications are selected, dosage is started low, and titration is upwards until effective pain control is accomplished. During this process the patient is carefully monitored for adverse effects. Opioid medications do not have any absolute maximum dosage, the limit being the induction of respiratory depression.

This treatment is in strict conformity with the guidelines. The treatment consistently results in the effective treatment of chronic pain, without medical complications, adverse effects, aberrant behaviors or evidence of the induction or worsening of any addictive disorder. Effective treatment allows patient to make progress in their quality of life, physical status (frequently with dramatic improvement in their range of motion and social and physical functioning.) They consistently suffer no adverse effects or medical complications. Their progress is consistently documented. Their pain regimen typically becomes stable within 90 days and remains so, without significant variation or change, for periods from 24 to 180 months in my research series.

The treatment is consistently supervised on a timely basis during the entire course of treatment and is unarguably of medical necessity. Patients provide outcome letters which are definitive as to the efficacy and safety of treatment. In most cases, because of the unresolvability of the underlying pathology, their pain management will typically be indefinite.
Sincerely, J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org