Joranson David E, Gilson Aaron M, Dahl June L, Haddox J David
Pain & Policy Studies Group, Madison, WI 53711, USA.
J Pain Symptom Manage. 2002 Feb;23(2):138-47. doi: 10.1016/s0885-3924(01)00403-1.
Physicians' concerns about regulatory scrutiny and the possibility of unwarranted investigation by regulatory agencies negatively affect their prescribing of opioid analgesics to treat pain. Indeed, some state medical boards have rejected prescribing practices that are considered acceptable by today's standards. This article describes a ten-year program of research, education, and policy development implemented by the Pain & Policy Studies Group aimed at updating and clarifying state medical board policies on the use of opioid analgesics to treat pain, including cancer and chronic noncancer pain. Following surveys of medical board members and educational workshops, state medical board policies began an initial period of change, drawing on guidelines from other states, particularly in California. The next phase of policy development was marked by the introduction of Model Guidelines by the Federation of State Medical Boards of the U.S. The Model Guidelines address professional standards for the appropriate prescribing of opioid analgesics for pain management, as well as physicians' fears of regulatory scrutiny. Although most state medical boards have adopted regulations, guidelines, or policy statements relating to controlled substances and pain management, to date ten boards have adopted the Model Guidelines, while ten more have adopted the Model Guidelines in part. Further actions are recommended so that state medical boards can address inadequate pain management and physician concerns about regulatory scrutiny.
医生对监管审查以及监管机构进行无端调查可能性的担忧，对他们开具阿片类镇痛药治疗疼痛的行为产生了负面影响。事实上，一些州的医学委员会拒绝了一些按照当今标准被认为是可接受的处方做法。本文介绍了疼痛与政策研究小组实施的一项为期十年的研究、教育和政策制定计划，旨在更新和阐明州医学委员会关于使用阿片类镇痛药治疗疼痛（包括癌症疼痛和慢性非癌症疼痛）的政策。在对医学委员会成员进行调查并举办教育研讨会之后，州医学委员会的政策开始了初步的变革阶段，借鉴了其他州（尤其是加利福尼亚州）的指导方针。政策制定的下一阶段以美国州医学委员会联合会引入《示范指南》为标志。《示范指南》涉及阿片类镇痛药用于疼痛管理的适当处方的专业标准，以及医生对监管审查的担忧。尽管大多数州医学委员会都通过了与受控物质和疼痛管理相关的法规、指南或政策声明，但迄今为止，有十个委员会采用了《示范指南》，另有十个委员会部分采用了《示范指南》。建议采取进一步行动，以便州医学委员会能够解决疼痛管理不足以及医生对监管审查的担忧问题。
