Editor of The Circle from NACC’s Board of Directors,

We wish to respond to the front page article, “NACC Changes Pain Prescription Policy,” in the May, 2013, edition of The Circle

First and foremost, we want to emphasize that NACC is concerned about patient’s pain. The central issue, however, is how we approach treating chronic pain.

We would like to call your attention to several important points:

1.    Opioids (Vicodin, Percocet, etc) have not been proven to be effective or safe for treating non-terminal pain long-term. (Whereas they can be effective and relatively safe for treating acute pain and pain during terminal illness.)

2.    National Guidelines for chronic pain treatment include: FIRST using a non-drug treatment and SECOND using medicines based on type of pain and patient’s other medical conditions. Physical therapy is a very effective and under-used method to treat muscular pain. As a society we have become used to using pills for things that exercise, stretching and massage can heal in a more lasting way.

3.    Because opioids are powerful and potentially harmful drugs, a thorough work-up is advised and careful monitoring during the course of treatment must be followed. Pain clinics handle this better than regular health centers.

4.    With the increase in the number of opioid prescriptions in the recent past, there has been an increase nationwide in the number of deaths due to unintentional opioid overdose.

5.    In addition, most patients on chronic opioids will develop tolerance (need for more drug to produce same level of pain control) and physical dependence (uncomfortable symptoms when drug is withdrawn), even if they aren’t addicted. Add to that the prescription of opioids in a chemically dependent patient and the issues become more complex.

CONCLUSION:  NACC does care about pain issues in the people we serve.  However, because the treatment of chronic pain is complex and requires special skill and experience to prescribe and monitor chronic opioid therapy in a safe and effective manner, we feel it is safer to refer to a pain specialist those patients who have not been helped by the other methods and non-opioid medicines we recommend.

We hope that the above explanations will help you to understand our position.

Sincerely, NACC Board of Directors:  

Pat Bellanger, Clyde Bellecourt, Jean Forster, Anthony Genia, Lyle Iron Moccasin, Dr. Carol Krush, Larry Leventhal, William Means, Naida Medicine Crow, Elaine Salinas, Sharon Schaschal, and Joanne Stately.