Philosophical Approach to Opioid Medication Prescribing

Opioid medications are just one of many clinical tools available for chronic pain management. Our clinical philosophy emphasizes that opioid medication should only represent a small fraction of the therapeutic toolset to help patients improve function and quality–of–life measures. 

To those patients who desire to have opioid medications included as part of their chronic pain management regimen, I urge them to review the following document and guidelines. 

The intent of this document is to inform patients of the pain management philosophy of our practice before they invest time and resources to attend an appointment at this clinic. A clear understanding of our clinical policies and approaches regarding opioid prescribing is important to provide a good doctor–patient relationship to achieve better outcomes in pain management. 

Central to the philosophy of this clinic is the goal of optimizing patients‘ quality of life with improved activity tolerance and reduced overreliance on high–risk opioid and anti–inflammatory (NSAID) medications. 

At Non–Surgical Pain Specialist (NSPS), we believe the doctor–patient relationship thrives on mutual agreement and shared understanding of expectations. It is only when both parties work as a team that we can effectively improve the patient’s pain, function, and quality of life. 

Dr. Haber’s approach is to treat patients the way he would want his family members to be treated. Therefore, if a patient requests him to prescribe a medication regimen that he would not want for his own family member, he will not prescribe it for that patient. When considering treatments and diagnostic options, Dr. Haber will only offer those options that he is comfortable providing to his patients. If a treatment option is desired by the patient but not offered at NSPS, patient referral to another clinic would be undertaken. 

Extensive research has not shown that long–term use of opioids had resulted in a significant improvement in patient quality of life or function. While opioid medications may help reduce pain severity by 10-30% for hours or weeks, but often with long–term use, opioids can induce increased pain, dependence, and tolerance. 

Opioids are high–risk medications and require close scrutiny to ensure safety and compliance with governmental prescribing guidelines. For the patients attending our clinic, inclusion of an opioid medication as part of a medication regimen may or may not be considered for a particular patient or situation. 

For each new patient at their initial appointment, a full clinical evaluation will be performed by Dr. Haber prior to developing a diagnostic and treatment plan. Under no circumstance will Dr. Haber simply renew a medication regimen based on another clinic’s prior management of this patient. Furthermore, medications will not be prescribed at the first clinic visit at NSPS. 

There are multiple government clinical treatment guidelines for pain management. They address the minimum steps mandated prior to providing opioid treatments and continue subsequently. The intent of guidelines is to achieve safer prescribing to benefit both the patient and the community. While a guideline may set an upper limit for a treatment parameter, every clinician reserves the right to provide treatment approaches they are comfortable with based on their own clinical and educational experience. Therefore, actual prescribing may be less than guideline set limits.