It’s all over the headlines about the misuse of opioids and the addiction epidemic we have in this country. As such, general primary care doctors are struggling how to treat their patients with chronic pain these days and not contribute to or start them down the path of addiction. Pain center specialists are quick to admit that they have a delicate balance with their patients who are dependent on these drugs and how they treat them.
One of the biggest challenges that all doctors have is the lack of being able to estimate of how common problematic opioid for chronic pain patients can develop. The biggest majority of those who have chronic pain don’t go on to develop such an addiction.
But because so many have, creating the current epidemic, the medical industry needs to get a better understanding on how to effectively manage the risk of drug abuse.
A pain center doctor should take precautions and look for any potential risks of substance abuse before prescribing any medication to any patient with chronic pain. This would include looking at the patient’s medical history, their family medical history including any type of psychiatric disorders or substance abuse.
If any of these are present in a patient’s past, it doesn’t mean they should be automatically denied medication. But they should be educated and informed about the risk of drug dependence and then monitored closely for potential abuse.
Medication Isn’t Always The Answer
What more doctors and patients need to realize is that medication doesn’t always have to be the answer for chronic pain. There are the false assumption and misunderstanding that medication makes the pain disappear. But when it comes to chronic pain situations, that isn’t necessarily so. For many people, it only will reduce their pain. And this is where referral to a pain center is important.
Treatment Without Opioids
For those patients that have a substance abuse history, or psychiatric disorders, a pain center can provide many other ways to get that pain relief without using opioids. A pain center that works with a multidisciplinary approach can treat patients with chronic pain regardless of their history.
And there are medications that can be prescribed that are non-opioid drugs to go along with the other methods as well. Like antidepressants, anti-arrhythmic drugs, and anti-epileptic drugs, all of which are effective to treat chronic pain.
A pain center also offers physical therapy, psychological therapies, as well as occupational therapy. There are so many people suffering from chronic pain that is not receiving the services of a multidisciplinary pain center because it usually requires academic medical center resources and not all doctors have these resources. They can, however, collaborate with doctors that do.
After a doctor has taken in all the information about a patient and considers all the possible options that are available and believes an opioid treatment is needed, but the patient is opioid-dependent, there are some other medical options. Both buprenorphine and methadone have the benefits of being a strong analgesic and may be just what the patient needs.
When a pain center treats patients with chronic pain and has a substance abuse disorder, they will also include psychological counseling in the treatment plan. It may be group therapy or individual therapy, but when substance abuse overlaps with treatment for chronic pain, the behavioral and psychological skills are the same.
For pain doctors that work independent or with a pain center, an opioid contract is a common thing to request patients sign before they begin treatment. It is an effort to establish a clear understanding between the medical team and the patient that opioids are only allowed that the doctor prescribes and can only come from the pain center’s pharmacy or a designated pharmacy.