Interview with Robert Twillman, M.D. – Question #1

Dr. Lynn Webster: Hello, this is Dr. Lynn Webster. Thank you for listening to this pain topic series of interviews on 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 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.

Let me ask you the first question, “What do you see are the major differences, or similarities, to the prescription drug abuse problem and chronic pain problem in America?”

Dr. Robert Twillman: I think it’s interesting that often times we see these two problems played off against each other as though anything we do to try and fix one makes the other one worse. It leaves us in a bad situation because we can’t ever achieve a really good outcome with each one. The more I think about this, the more I see that there are a lot more commonalities between prescription drug abuse and chronic pain than there are differences.

Just to pick of a list of those, they are both very highly prevalent, we see prescription drug abuse in more or less 12 million people in the United States every year and of course 100 million people have chronic pain. They’re both very costly in terms of both economic cost and the human cost associated with them. They are both very highly stigmatized, and often times the patients are blamed for having these problems.

There’s a sense within our society that if you have a problem abusing drugs or if you have a problem with chronic pain, it’s because you’re not doing something right as opposed to viewing these as the medical conditions that they really are. Both of them involve tremendous suffering, not just for the patients who are involved but for their families and everyone else who’s attached to those folks. They are both poorly understood by the medical profession, and we don’t do a very good job teaching about either one of these problems in medical school and in subsequent training.

There’s the well‑known statistic out there that the medium number of hours of pain management content in medical schools is nine hours, and I don’t have a source on this. But I’ve been told, by some folks who are very well versed in the numbers, that the content in medical schools on addiction is only about four hours. It’s even less than they get on pain.

Dr. Webster: Bob, sorry to interrupt but I never had a single class on addiction.

Dr. Twillman: Yes. I’m not surprised. So how do we expect people to deal with this problem? It’s such a prevalent problem because, more or less, about 15 percent of the people in our population have some sort of addiction problem whether it’s drugs or alcohol or whatever. Just think about that for a minute.

For a busy primary care clinician who might see even just 35 patients on a days’ time. We are talking about five to seven of his patients who’ve got a problem, and I would wager that if you go in the most primary care clinics and looked at the list of patients per given day and said, “Tell me which ones have a problem,” they wouldn’t be able to do it. It really creates a lot of problems for us.

The other thing about this is that both of these are really complex problems, and there’s lots of things that contribute to them. We really have to look at them with the biopsychosocial model and try to provide treatment that really reflects that model as well. You want to be successful in dealing with them.

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 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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