Forget the Recipes: Let's Talk Data

Abstract

We appreciate Dr. O'Connor's interest in our sardonic commentary on the off-label use of Actiq and the opportunity to respond to his critique. Of course our reference to recipes in that piece referred to the media's formulaic approach to misrepresenting issues on the pain/addiction interface. We did not mean to imply that all opioids, and in particular rapid-onset opioids, were right for any/all patients with cancer or noncancer pain. As psychologists and clinicians who work with both cancer and noncancer pain patients, we agree that there are important differences between these groups, as reflected in our previous works [1–3]. Thus, our piece was meant to comment on the ramifications of the Food and Drug Administration's (FDA) singling out of a particular product or products for this type of labeling. Dr. O'Connor raises several points wherein he disagrees with our views, but in so doing, he often confounds the general issue of Actiq or rapid-onset opioids in noncancer pain, which obscures, at times, the discussion of labeling. Nevertheless, he raises issues that require a data-driven response. Let us first dispute Dr. O'Connor's contention that the population of people with cancer pain and those with noncancer pain are so different as to make such labeling distinctions legitimate. With 12 million people presently living post-cancer in the United States, many of whom have chronic pain syndromes, and some having “morphed” into chronic opioid therapy patients, the differences are not nearly as dramatic as they once were between these two populations. Indeed, we presently have a Mayday Fund grant to study pain in survivors and its treatment. The decision to write this grant was driven by our experience in Kentucky running a palliative care clinic that was nearly evenly split between people with advanced cancer and those with chronic pain syndromes in long-term …