Chronic pain management: How to treat it without overmedicating
Powerful prescription painkillers such as OxyContin, Percocet and Vicodin are now the most widely abused drugs in the United States — surpassing even crack cocaine. And, according to an article in ScienceDaily® that cites a Journal of Clinical Psychiatry report, they cause more overdose-related deaths than heroin and cocaine combined. This epidemic of prescription opiate painkiller addiction in the United States has recently caught the attention of media outlets such as CNN, MSNBC and CurrentTV.
While critics have lambasted pain medicine clinics as "pill mills" and the drugs they prescribe as "hillbilly heroin," practitioners of the pain medicine discipline argue that chronic pain is a legitimate medical diagnosis, and that these medications serve a vital medical purpose when properly prescribed. With abuse and addiction of these prescription pain medicines rampant, how can health care providers treat pain without overprescribing potentially harmful drugs?
"Standalone pain medicine clinics serve a legitimate purpose — provided the practitioners run these clinics responsibly," says Erich Widemark, PhD, RN, FNP-BC, director of nursing at the Phoenix Main Campus of University of Phoenix, and a nurse practitioner who once worked in a pain clinic. "A proper pain medicine clinic should do everything reasonable to ensure that the wrong people do not receive medications through proper education, screening and close monitoring. These clinics serve a patient population that is often ignored or judged inappropriately."
Pain clinics must operate responsibly
That said, Widemark concedes that not all pain clinics operate responsibly. “I worry about clinics that will see 40 to 50 patients per provider per day," he says. "Pain patients need time for evaluation and education, but there is not a lot of money in medication management, so some practices choose to increase the volume to make up for that."
Randall Hamilton, RN, MSN, FNP-BC, is area chair for the University of Phoenix nurse practitioner program and also works as a nurse practitioner in a standalone pain clinic. He agrees with Widemark’s assertion that pain clinics serve a vital need when operated responsibly. "The difference between reckless and responsible pain centers is based on utilizing safeguards and prescribing opioids only when warranted," he explains. Conditions that can lead to a chronic pain diagnosis include degeneration of the neck and spine, osteoarthritis, rheumatoid arthritis, diabetes-related neuropathy, and even traumatic brain injury (TBI), according to Hamilton.
Many effective treatment options for pain management don’t involve painkillers
While chronic pain can be debilitating, Hamilton emphasizes there are other treatment options for it besides prescription opioids like OxyContin. "Depending on the type and location of the pain, alternatives include epidural steroid injections, physical therapy, massage therapy, acupressure/acupuncture, biofeedback and meditation," he says. "An exercise program has also been shown effective in relieving pain by releasing endorphins, which is a natural opioid substance released by the brain."
Widemark stresses that responsible practitioners always consider all available options when treating patients for chronic pain. "Medical practitioners need to approach chronic pain treatment using a multidisciplinary approach that includes counseling, physical therapy, emotional support, medication management and, if appropriate, interventional treatments," he says. "Chronic pain is a legitimate medical diagnosis."