RE: Fishbain DA, Lewis JE, Gao J, Cole B, Rosomoff RS. Alleged breaches of standards of medical care chronic opioid analgesic therapy, application of the controlled substances model guidelines: case report. Pain Med 2009; 10(3): 565-572.

摘要

I was quite dismayed when I read the case report on alleged breaches of "standards of medical care" in a patient overdose death possibly related to chronic opioid analgesic therapy, application of the controlled substances model guidelines: case report by Dr. David Fishbain. He defended all of the allegations while I agreed with most of them. More importantly, I feel a key element was left out. On page 568, he related the guidelines state that the decision to start chronic opioid analgesic therapy (COAT) should be based on a diagnosis and clear documentation of chronic pain unresponsive to other treatments. Dr. Fishbain glossed over the very important first element, that is, diagnosis. The diagnosis listed was "chronic right shoulder pain." This is a symptom, not a diagnosis. This is a 27-year-old female who fell out of bed 7 months earlier! What injury could occur in a young person from a fall that shallow that would not heal in 7 months? And how could it be so severe as to require Hydrocodone 10 mg four times a day? And the pain scales ranged from 6/10 to 9/10 during opioid treatment (and the patient still functionally impaired), therefore, the patient was not responding to opioid treatment, but left on it anyway?