The editorial by Mitchell Katz1 describes his frustration in caring for patients with complex pain along with medical illness and substance abuse problems. He argues against the recommendations for careful assessment and monitoring contained in the recently published evidence-based guidelines for the use of opioids in chronic noncancer pain.2 Rather, he suggests that these recommendations interfere with the physician-patient relationship and facilitate the physicians' distrust of the patients' compliance with opioid therapy. Instead, he calls for consensus guidelines to establish a maximum dose for long-term treatment of chronic noncancer pain with opioids. He bases this in part on the dosage levels he estimates from the Braden report,3 which we were unable to confirm from the report and suspect that Katz overestimated the doses.
Foley KM, Fins JJ, Inturrisi CE. A True Believer’s Flawed Analysis. Arch Intern Med. 2011;171(9):867-868. doi:10.1001/archinternmed.2011.166