Intended for healthcare professionals

Rapid response to:

Letters CDC guidelines on opioids for chronic pain

Analgesics or pain, who is the real enemy? Suggestions from the CDC guidelines

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2028 (Published 12 April 2016) Cite this as: BMJ 2016;353:i2028

Rapid Response:

Analgesics or pain, who is the real enemy? Certainly the pain, but also the undertreatment

There is no doubt, unnecessary pain is the real enemy.
Medications are tools that allow the management of patients with pain. NSAIDs, opioids, muscle relaxant, anti-depressants, anesthetics, antiepileptics, etc., all have to be used to reach the minimum effective dose, for the correct period of time, according to the approved indications, and with frequent monitoring.
In cancer and non-cancer pain are lacking standard diagnostic and therapeutic pathways and among specialists and GPs can often see different perspectives. The implementation of shared care pathways between GPs and hospital could reduce the gap and improve the level of management of patients with chronic pain.
Currently the GPs is virtually excluded from clinical research on the home care patient's pain management. But it would be very interesting to understand the effects of analgesics in clinical practice to understand the role of drug interactions, management of adverse events and quality of life of patients with chronic pain in the home care. GPs should propose a care pathway to determine when to refer the patient to the pain clinic.
Many patients currently suffer from pain and they are waiting many hours (or days) to receive appropriate therapy to reduce the intensity of pain in the shortest possible time. The undertreatment is another enemy to fight.

Competing interests: No competing interests

13 April 2016
Maggiori Enrica
General Practice
Local Health System
Rome, Italy Via Bussoleno, 9