IS MIGRAINE A COMPLEX REGIONAL PAIN SYNDROME OF THE BRAIN? MIGRAINE PROPHYLAXIS WITH VITAMIN C?

To the Editor: Throughout an article recently published in Pain Practice, the authors recommend the use of urine drug testing for patients with pain, and yet they write in the conclusion there is no evidence it would improve outcomes. In support of that statement, a recent systematic review of studies looking at the use of controlled substance agreements and urine drug testing found “. . . that weak evidence supports the use of treatment agreements and urine drug testing to reduce opioid misuse, despite the theoretical benefits of these strategies.” In addition, the article did not address questionnaire design or issues pertaining to the possible impact drug testing may have on the patient and the doctor–patient relationship. Also, the authors did not discuss potential legal issues with conducting suspicionless searches or invading one’s privacy, both of which may be constitutionally prohibited. Physicians in the employ of state or federally funded organizations, such as an academic pain center or Veterans Administration hospital, are considered “government actors” and are subject to both state and federal constitutions (see New Jersey v. T. L. O., 469 U. S. 325, 335–337 [1985]). Moreover, consent to search urine often comes from a controlled substance agreement, and there are questions as to whether agreements are legally valid. Until there is evidence that urine drug testing provides greater good than harm, it should be used with caution.