Corporate relations council members who pay another $60,000 also can have their educational programs included as satellite dinner symposia at the academy's annual meeting in Palm Springs -- a meeting slated for Feb. 23-26. An academy brochure describes the meeting as an "exclusive venue" for presenting continuing medical education material for doctors.
Saigh said payments by pharmaceutical companies do not give them the right to influence positions or statements made by the academy.
The American Pain Society, which funded the 1996 consensus statement on opioids and chronic pain, received more than $1.6 million in financial support from opioid companies in the last two years, more than 20% of its revenue, according to figures it provided for this story.
Its president, Seddon Savage, MD, an addiction and pain medicine specialist, declined to be interviewed for this story, but provided written responses.
In her statement, Savage, an associate adjunct professor at Dartmouth Medical School, said there is no evidence of the impact the statement had on opioid prescribing. The statement is not an official society document "at this time," she said.
She said it was unfair to say that the society's position on opioids has been influenced by pharmaceutical companies. The society did not advocate for or against the use of opioids, she said.
"For some individuals with pain, opioids relieve disabling suffering and allowed them to re-engage in a life worth living," she said. "For others, opioids can be associated with serious harm."
She said the group's position now is reflected in clinical guidelines issued in 2009. The guidelines were commissioned by the American Pain Society in conjunction with the American Academy of Pain Medicine.
The new guidelines say doctors can consider a trial of opioids for patients with chronic pain, but acknowledge that the evidence for such a "trial" is low-quality or insufficient.
And even that 2009 guideline document is tainted by allegations of pharmaceutical industry influence.
In 2008, Joel Saper, MD, a Michigan pain specialist, resigned from the guidelines committee, in part citing support of the project by the opioid industry.
Saper who has worked as an advisor to numerous drug companies, including those that make headache medications and opioids, provided a copy of his resignation letter to the Journal Sentinel/MedPage Today.
"The sponsoring organizations have received a large amount of funding from the opioid manufacturers over the past decade," wrote Saper, director of the Michigan Head Pain & Neurological Institute, in Ann Arbor. "Many members of the committee have personally received sizable funding from the opioid industry as well."
Disclosure statements accompanying the guidelines indicate 14 of the 21 people who served on the project had financial ties to companies that make opioids.
In a statement to the Journal Sentinel/MedPage Today, Roger Chou, MD, who chaired the guidelines project, said Saper never brought up any concerns about financial ties to drug companies prior to his letter.
Chou, an associate professor of medicine at Oregon Health & Science University, has no financial relationships with drug companies.
Pseudoaddiction: A Non-starter
Closely tied to the addiction issue is a term -- pseudoaddiction -- that has been widely used in the field of pain medicine.
When patients seek more frequent prescriptions or higher doses of opioids, it often is a sign of addictive behavior. But the pseudoaddiction approach -- essentially taking them at their word -- argues they aren't addicts, they just need more pain relief.
Even doctors who have financial relationships with opioid makers concede that term is not backed up by good science.
"It obviously became too much of an excuse to give patients more medication," said Webster, the Utah pain specialist and officer of the American Academy of Pain Medicine. "It led us down a path that caused harm. It is already something we are debunking as a concept."
The term was coined by Haddox, the doctor who is now a Purdue Pharma executive, and David Weissman, MD, a Medical College of Wisconsin physician, who used it in a 1989 paper in a medical journal. Weissman, now retired, could not be reached for comment.
Haddox, vice president of health policy at Purdue, declined to comment.
In the paper, the two used the term to describe a teenage leukemia patient with pneumonia and chest-wall pain who was being treated at a hospital.
But without adequate evidence, over the years it became an established belief in the world of chronic, non cancer pain.
It can be found throughout the pain literature, ranging from American Pain Foundation documents to documents issued by the Federation of State Medical Boards, the national group representing state medical boards. The FSMB includes pseudoaddition in its , model policy for the use of controlled substances in treating pain.
Steven Weisman, MD, a professor of anesthesiology and pediatrics at Medical College of Wisconsin, said there is one group of patients who might accurately be described as suffering pseudoaddiction -- sickle cell patients who develop chronic degenerative hip and back pain that responds to treatment with morphine.
But even pain specialists such as Russell Portenoy, MD, who has had extensive financial ties to opioid companies, now acknowledge that the concept of pseudoaddiction in chronic pain was not supported by evidence.
"The term has taken on a bit of a life of its own," said Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York, "That's a mistake."
Portenoy conceded there has been a lack of evidence supporting the use of opioids in chronic non-cancer pain, but said much of medical care is not based on rigorous evidence.
"This is not a simple story," he said.
Same Tune, Different Words
It reminds Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, of the situation that existed a decade ago with antibiotics.
The drugs were being vastly over-prescribed. They were being given to people with viral-based respiratory infections, against which they were useless. Or they were given to children for undocumented throat infections.
It wasn't until the situation became the focus of public attention that the inappropriate use of the drugs declined, Bauchner said.
"I'm hoping we can write the same story about opioid use in a decade," he said.
(Copyright MedPage Today, LLC. All Rights Reserved); visit http://www.medpagetoday.com
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