Therapeutic Alliance

Another major consideration is therapeutic alliance. As in every study of treatment outcome in psychiatric medicine, a strong therapeutic alliance is a significant predictor of success. So also in the treatment of pain, a positive transference between the patient and the prescribing physician is the best guarantee of treatment compliance. Therefore by firm policy the prescription of medications should be consistently limited to a single physician and, if at all possible, to a single pharmacy. Rotating physician coverage, or practice in a clinic setting in which multiple physicians attend the patients, should be avoided in every instance. Long-term treatment is also always more reliable than brief intervention, and in-depth knowledge of the patients, their diagnoses, and their course in treatment is an essential and powerful positive influence - for the reduction of pain, for effectiveness of pain medication and rehabilitative interventions, for the reduction of the need for medication, and for the avoidance of tolerance, diversion or recreational abuse of medications. When patients unequivocally know that they are well-known to the treating physician, abuse of treatment is highly unlikely. Assembly-line medicine virtually guarantees treatment failure and pharmacological dependence and abuse.