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How Risky is the Pain Treatment I am Considering

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When a medical practitioner prescribes a medical treatment for pain, one of my first questions is whether there are side effects or other potential risks. I contend that every pain treatment is inherently risky; the question is how much risk is associated with a particular treatment. Most of us probably rely on the medical practitioners with whom we work to understand the risks associated with the pain treatments we are considering. Medical practitioners can rely on information from patients to assess treatment risks, but this method is problematic because some side effects may be specific to an individual or may not have occurred in the individuals with whom the practitioner spoke. Therefore, we need a more rigorous and systematic way to assess treatment risks. This more rigorous and systematic method of assessing treatment risks is already in place through the Food and Drug Administration (FDA), which requires that every pharmacological pain treatment approved for sale be examined for safety and effectiveness. Therefore, when a medical practitioner prescribes a given pain medication approved by the FDA for the medical condition being treated, s/he can relay information about treatment risks based on data from thousands of patients.

Even when pain treatments are regulated by the FDA, there is still room for uninformed use of the treatment. Clinical trials examining the effectiveness and safety of pain medications may be published in professional journals in addition to being vetted by the FDA. If a practitioner relies on these professional publications to understand treatment risks, then the practitioner’s ability to understand any risks associated with the treatment depends on the inclusion of this information in the publication. Research by several groups of scholars examining how thoroughly papers in professional pain journals report treatment risks (which are called ‘adverse events’ in the field) suggests that better reporting is necessary to provide the information needed in order for practitioners and consumers to make informed decisions about pain treatments. Some of these scholars have focused on non-pharmacological treatments that are not regulated by the FDA (e.g., acupuncture, psychotherapy, hydrotherapy, yoga). One could argue that the need for better risk reporting is even greater for these kinds of treatments because professional publications are the only place where one can find rigorous and systematic assessment of risks for treatments not regulated by the FDA.

So, what can we do about this, as scholars, practitioners, or consumers? As scholars (or practitioners involved in research), we can be conscientious about reporting adverse events. We need to report how we measured adverse events, the number of people receiving the pain treatment who experienced each adverse event, and the number of people not receiving the pain treatment of interest who experienced each adverse event, etc. In short, readers need to have enough information to assess whether risks were adequately assessed and to evaluate the chances that an adverse event will occur. If we are practitioners, we can search the research literature to understand the risks associated with treatments; if you are not sure how to do that, find someone at a facility or institution who is an expert on the treatment and contact the person to find out about resources. If you are a consumer, ask your medical practitioner about scientific information regarding the risks associated with the treatment.

About Matthew Hunsinger

Matthew HunsingerMatthew is an experimental psychologist.  He has an M.S. in Cognitive Science from Illinois State University and a Ph.D. in Experimental Social Psychology from the University of Massachusetts.  Matthew has been involved in pain scholarship for several years.  He became involved in this area of research in order to use science as a tool to improve the quality of life for individuals; in this case, to use scholarship as a way to impact the way pain research is conducted and the accessibility of important information about pain treatments.  He currently is an assistant professor in the School of Professional Psychology at Pacific University

Reference

Hunsinger M, Smith SM, Rothstein D, McKeown A, Parkhurst M, Hertz S, Katz NP, Lin AH, McDermott MP, Rappaport BA, Turk DC, & Dworkin RH (2014). Adverse event reporting in non-pharmacologic, non-interventional pain clinical trials: ACTTION systematic review Pain : 10.1016/j.pain.2014.08.004

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