Opioids for chronic noncancer pain: A position paper of the American Academy of NeurologyAuthor Response

Editors' Note: The topic of this week's WriteClick is the American Academy of Neurology's position paper on opioids for noncancer pain. Dr. Katz considers 2 potential contributing causes to the opioid overuse epidemic: pharmaceutical companies and hospitals with an eye on patient satisfaction scores. Dr. Swerdloff discusses pain as the fifth vital sign. Dr. Brass suggests adding “Patients placed on opiates should also be screened for sleep-disordered breathing” to the list of recommendations. Drs. Argoff et al. cite 4 additional studies claiming to demonstrate long-term benefits of opioid analgesic therapy. Author Franklin answers all points. —Megan Alcauskas, MD, and Robert C. Griggs, MD Franklin1 provided an excellent review on the opioid overuse epidemic. Considering the immensity of the topic, treatment within a single article may be impossible. The cause of this epidemic should have been considered in more detail. While the push by certain physicians and societies was noted, the influence of pharmaceutical companies was not mentioned. The marketing machine that helped drive the increased use of opioids for noncancer pain is controversial but cannot be disregarded. Similarly, the pressure by hospitals and health care organizations to chase the patient satisfaction metric is a contributor to the epidemic. I can attest that patient complaints about not receiving opioids influence a physician's position in a hospital and a study has documented how chasing this metric can lead to increased mortality. …