Question
Could Michael Jackson's untimely death have been prevented if standards of medical care regarding chronic pain management were in place?
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Response from Aaron M. Gilson, MS, MSSW, PhD Senior Scientist, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin |
News reports have suggested that Michael Jackson's untimely death did not result from a particular incident or a singular etiology. It is possible that his alleged history of substance abuse or reported anorexia could have increased his potential for a cardiac event, but even this is uncertain. The popular press suggest that Michael Jackson suffered from chronic pain. Of course, the question of whether his life would have been prolonged with effective pain treatment cannot be answered, but it does point to a need to understand what current resources are available that provide medical practice standards for chronic pain relief.
The question above suggests an absence of readily available national practice standards, but this, fortunately, is not the case. Since 1994 there has been a clinical practice guideline for cancer pain management, first published by the Agency for Health Care Research and Practice (now called the Agency for Healthcare Research and Quality) and then updated by the American Pain Society (APS) in 2005. It was not until 2009 that the first comprehensive clinical practice guideline was created jointly by the APS and the American Academy of Pain Medicine (AAPM) for the treatment of chronic noncancer pain. The overall guideline message is that opioids are safe and effective for carefully selected and well-monitored patients. Given the general controversy surrounding chronic opioid therapy for noncancer pain, the APS/AAPM guideline emphasizes the essential need for a risk/benefit assessment to inform clinical decisions to initiate and maintain prolonged treatment with opioids. Such an analysis should be seen as fundamental not only to chronic pain management, but also to the general practice of medicine, which requires managing risk in relationship to the anticipated benefits of any treatment.
In addition to these national clinical practice guidelines, healthcare agencies in some states have created practice guidelines for treating chronic pain. For example, the Wisconsin Medical Society Task Force on Pain Management developed chronic pain guidelines that offer both national and state-specific assessment and management resources. Also, standards of medical care are established through state laws and regulations that govern general healthcare practice. In many states, standards are present that are specific to the use of controlled substances for chronic pain management. A list of these policies for every state, as well as a link to the exact language in each policy, is available at http://www.painpolicy.wisc.edu/matrix.htm.
Although diverse, what these clinical practice guidelines have in common is the underlying assumption that opioid treatment for chronic pain requires prescribers to have clinical skills and knowledge about opioid medications, the principles of opioid treatment and maximizing therapeutic benefit, and the assessment and management of adverse events and other risks. These guidelines and other standards represent important resources for the practitioner. Healthcare professionals, however, typically are not aware of these materials, which substantially limits their favorable impact on clinical practice. As a result, it remains essential to achieve successful methods to effectively disseminate this knowledge and accumulated resources to practitioners to ensure quality healthcare practice for all patients.