Interview with Robert Twillman, M.D. – Question # 3

Dr. Lynn Webster: Hello, this is Dr. Lynn Webster. Thank you for listening to this pain topic series of interviews on lynnwebstermd.com. Today I’m proud to have Dr. Bob Twillman, most of you probably are aware of Dr. Twillman.

 

Dr. Lynn Webster: Hello, this is Dr. Lynn Webster. Thank you for listening to this pain topic series of interviews on lynnwebstermd.com. Today I’m proud to have Dr. Bob Twillman, most of you probably are aware of Dr. Twillman.

He is executive director for the American Academy of Pain Management and I believe is probably the most knowledgeable person about federal and state pain policies in the country. That’s going to be primarily our topic today. Let me just get started. Bob, thank you for joining us and thank you for participating in this podcast.

The CDC is planning to offer opioid prescribing guidelines. They sent out an RFP just last year for comments in developing their own set of guidelines. Don’t we have guidelines now? What do you think the CDC can offer that’s not already been proposed?

Dr. Robert Twillman: Frankly, that RFP mystifies me, just a bit, for a number of reasons. First of all, it’s actually part of an effort that I helped kick off with them. I chaired a work group that worked with some folks at CDC looking at the evidences out there, the guidelines that already are out there.

What we did was to collect all of the guidelines we could find and put them in a grid and looked at what features they had and what features they didn’t have. Our conclusion was that there was a lot more missing from those guidelines than there was present. What was present was all over the place, different recommendations from different guidelines.

The bottom line is that, the reason for that is there’s very little evidence on which to base those guidelines, they are essentially consensus guidelines of experts. Secondly, just this past winter, I believe it was, NIH hosted a program where they looked at the evidence on prescription drug abuse and treatment of chronic pain using opioids. The conclusion that came out of it is that clinicians have no reliable evidence on which to base any decision they make in treating chronic pain.

So we’ve got one agency of the government saying that we have no evidence, and we have another agency, the CDC, saying we want to produce some evidence‑based guidelines. So I’m wondering what evidence they’re going to use to produce this guideline. And if they fix strictly to evidence, it’s probably going to be a very short guideline because they won’t have much to say. What I’m most concerned about is that what they are going to produce is essentially a consensus of consensuses and I’m not sure that moves us forward.

Dr. Webster: Bob, I want to thank you very much for participating over the last couple of weeks answering the questions and contributing to, I think, a knowledge base for a lot of the listeners. I also want to thank the listeners to this Pains Topics interview on lynnwebstermd.com. If you aren’t already, please follow me on twitter @lynnrwebstermd.

Also, stay tuned to my blog for more information about my upcoming book and documentary both titled “The Painful Truth” to be released this fall. The book will be available September 1. Have a great day.

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