About the AMA and pain management

About the AMA position on pain management using opioid analgesics

Unbalanced and misleading media coverage on the abuse of opioid analgesics not only perpetuates misconceptions about pain management; it also compromises the access to adequate pain relief sought by over 75 million Americans living with pain.

In the past several years, there has been growing recognition by health care providers, government regulators, and the public that the undertreatment of pain is a major societal problem.

Pain of all types is undertreated in our society. The pediatric and geriatric populations are especially at risk for undertreatment. Physicians’ fears of using opioid therapy, and the fears of other health professionals, contribute to the barriers to effective pain management.

In 2001, in an unprecedented collaboration, the US Drug Enforcement Administration (DEA) joined 21 Health Groups, including the American Medical Association, in calling for balanced policy governing prescription pain medications. In August 2004, the DEA issued a document entitled Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel, however, the agency withdrew its support for the document less than 2 months later saying that it "contained misstatements" and "was not approved as an official statement of the agency."
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The AMA supports the position that:

1. physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution. It is the policy of the AMA that state medical societies and boards of medicine develop or adopt mutually acceptable guidelines protecting physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain before seeking the implementation of legislation to provide that protection;
2. education of medical students and physicians to recognize addictive disorders in patients, minimize diversion of opioid preparations, and appropriately treat or refer patients with such disorders; and
3. the prevention and treatment of pain disorders through aggressive and appropriate means, including the continued education of physicians in the use of opioid preparations.

The Federation of State Medical Boards’ Model Guidelines for the Use of Controlled Substances for the Treatment of Pain, (PDF, 210KB) encourage adequate pain management and address physician concerns about disciplinary actions by medical boards. These guidelines were recently updated to ensure currency and adequate attention to the treatment of pain. Policies and guidelines of the American Pain Society, the American Academy of Pain Medicine, the American Geriatric Society, and the American Society for Addiction Medicine also encourage the appropriate use of opioid analgesics for pain management.

At its annual policy-making meeting in the summer of 2003, the AMA House of Delegates adopted policy recommendations stating their opposition to the harassment of physicians by DEA agents in response to the appropriate prescribing of controlled substances for pain management, as well as to the inappropriate use of 21 Code of Federal Regulations Section 1306.04 or any other rationale that would involve placement of licensure restrictions on physicians who use opioid analgesics and other pain-reducing medications appropriately to treat patients with pain. The AMA requests that state medical and specialty societies submit examples of physicians who allegedly have been harassed by DEA agents for appropriate prescribing of controlled substances for pain management to the AMA's Office of General Counsel.

The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain. And education is the best medicine. To this end, the AMA has created a national Pain Management CME program (currently being updated) for physicians to address many of these issues. The review board for this activity consists of expert reviewers from 16 medical specialty societies and other professional health care organizations. The CME program was funded through an unrestricted educational grant from Purdue Pharma, L.P.

Preventing drug abuse is remains an important societal goal—it should not hinder patient’s ability to receive the care they need and deserve or discourage physicians from prescribing pain medications when medically appropriate.

DEA/Health Groups Joint Statement

• Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act (PDF, 71KB)
• American Medical News article

AMA Policies Regarding Pain Management and Opioids

• D 120.983 Concerning Pain Management
• H-120.960 Protection for Physicians Who Prescribe Pain Medication
• D-120.985 Increasing Awareness of Opioid Pain Management Treatments
• D-120.999 Use of Opioids in Chronic Noncancer Pain
• H-95.954 The Reduction of Medical and Public Health Consequences of Drug Abuse

Policy Finder

AMA Pain Management CME Program: Pain Management: The Online Series
(currently being updated)

Other Organizations' Guidelines
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• Model Guidelines for the Use of Controlled Substances for the Treatment of Pain (Federation of State Medical Boards) (PDF, 210KB)
• The Use of Opioids for the Treatment of Chronic Pain (American Pain Society, American Academy of Pain Medicine) (PDF, 485KB)
• Cancer Pain Relief with a Guide to Opioid Availability (World Health Organization)
• Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain (American Pain Society)
• Definitions Related to the Use of Opioids for the Treatment of Pain (American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine) (PDF, 568KB)

Prevalence of Pain and Pain Undertreatment

• Chronic Pain in America: Roadblocks to Relief (American Pain Society)  

Contact Information

• For questions about the content of this page, send a message to Mark.Evans@ama-assn.org