The pre-registration deadline for "Pain Assessment and Opiates in the Workplace: Medical, Legal and Practical Issues" is July 29. For more information and to register, go to http://paincenter.stanford.edu.

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Opiates are the class of medications most effective for treating many types of chronic pain, but they are among the most controversial and problematic medications that physicians prescribe.

Doctors are often reluctant to prescribe opiates for several reasons: concern that patients will become addicted or lose the ability to function; fears of being targeted in a criminal investigation for prescribing the controlled substances; concerns about liability; and doubts about how to properly assess chronic pain, given that it is a subjective experience and may not be accompanied by objective signs of illness.

For physicians who grapple with these issues, an upcoming conference at Stanford should provide welcome information, clarification and guidance. It will also enable doctors to fulfill a new state CME requirement.

"Pain Assessment and Opiates in the Workplace: Medical, Legal and Practical Issues" will be held on campus Aug. 12-13, as a satellite symposium of the 10th World Congress on Pain (held Aug. 17-22 in San Diego). The symposium, sponsored by Stanford's Department of Anesthesia and a working group of the International Association of the Study of Pain, will convene an international panel of experts to discuss issues including opiates' effectiveness in alleviating chronic pain; their impact on cognition and functioning; physician liability as it relates to prescribing opiates; how physicians can appropriately (and legally) prescribe opiates; and how to appropriately assess patients' pain.

"There's still a tremendous amount of confusion and misconceptions about the role of opioids in treating chronic and malignant pain," explained Sean Mackey, assistant professor of anesthesia and pain management and co-chair of the symposium. "Doctors should come away from this conference with a much clearer understanding of the issues, and how to best run their practice so they can use these medications appropriately."

Other conferences have focused on opiates' effectiveness and the recommended guidelines for prescribing them, but this is among the first to specifically address opiates' impact on patients' cognitive ability as well as their ability to function and return to work.

While the conference will be of particular interest to those who regularly deal with chronic pain patients, rehab and workers' comp cases, Mackey emphasized that an understanding of pain management and proper opiate use would benefit virtually any physician. "Pain is something physicians deal with every day; it's the No. 1 reason people visit the doctor," he explained. And he noted that many physicians have had little to no training in pain management.

Speakers at the symposium will include pain management specialists from various countries; experts in medical-legal liability; and representatives from the California Highway Patrol and the U.S. Drug Enforcement Agency. The speakers will present the latest research-based findings on opiates, but "we also hope to stimulate rich discussion and exchanges of ideas" about areas that remain murky, Mackey said. Under a new state law, by the end of 2006 most California doctors must obtain 12 CME credits in pain management and the treatment of terminally ill patients. The "Pain Assessment and Opiates in the Workplace" conference has been approved for the required 12 CME credits.