Central Mass. hospitals seek pain-fighting Rx, minus opioids
By
Brian Lee
Telegram & Gazette Staff
Posted Feb 10, 2018 at 7:00 PM
Updated Feb 11, 2018 at 10:49 AM
Christopher Hallen of Leicester has chronic lower back pain from being rear-ended by a tractor-trailer seven years ago.
Aware of opiates’ potentially addictive pull, Mr. Hallen said he got off of his prescribed painkillers immediately. He said he didn’t want to become an addict and enjoys being able to look his three young children in the eye.
Mr. Hallen subsequently tried cortisone injections and various other options, but his most recent minimally invasive procedure resulted in him leaving St. Vincent Hospital in Worcester “laughing my butt off.”
Mr. Hallen said his physician, Dr. Shawn Kumar, provided him relief by literally burning his nerve endings, through a procedure called radiofrequency neuroablation. It was performed Friday.
Mr. Hallen said he feels so good he doesn’t even have to take ibuprofen anymore.
“Hands down, this is the only avenue I could’ve went, other than surgery at 35,” Mr. Hallen said.
Pain is the most common reason for office visits to physicians across the United States, accounting for 20 percent of outpatient office visits and a total annual cost of health care of approximately $635 billion. In addition to medical costs, the amount includes economic costs related to disability days, lost wages and productivity, according to an Institute of Medicine Report from the Committee on Advancing Pain Research Care and Education.
At the same time, Massachusetts providers have been issuing fewer opioid prescriptions in the wake of the crisis. A state Department of Public Health report last year said about 638,000 Schedule II opioid prescriptions were issued in the second quarter of 2017, representing a 28 percent reduction compared with the first quarter of 2015.
Dr. Kumar, an anesthesiologist and pain management specialist doctor
at St. Vincent, joined pain doctors from UMass Memorial Medical Center
in Worcester and Harrington Hospital in Southbridge in speaking about
alternatives to opiates for chronic pain.
Dr. Kumar said he hardly ever prescribes opioid use long-term.
In general, there has been a shift in the pain-treatment paradigm because of advances in the field.
Previously, he said, prescription opioids had been viewed as a viable alternative to undergoing a procedure for pain management, said Dr. Kumar, who previously worked at Rush University in Chicago.
“There’s certainly still a place for opiates,” he said. “There are patients that have tried everything and nothing else works. There are cancer patients. There are appropriate uses of opiates.”
But the premise of using opioids long-term, in the same way they’re prescribed for short-term pain management, has been somewhat debunked, Dr. Kumar said.
He noted a number of advancements in medical procedures and different
technologies that pain management doctors can use, including minimally
invasive injections and procedures.
Also, there are a host of more invasive procedures, such as spinal cord stimulations, that are good at controlling pain without using medications, he said. It delivers low-voltage electrical stimulation to the dorsal columns of the spinal cord to inhibit or mask the sensation of pain.
In the early 2000s, Dr. Kumar said, governing bodies mandated that pain control be prioritized as the “fifth vital sign” and be treated more aggressively. This ultimately led to more patients being exposed to opioids, the doctor said.
At that time it was not entirely clear how addictive opiates might be, and this in combination to a cultural shift led to people’s increased willingness to abuse them. An aging population has also contributed to the crisis, the doctor said.
And for some reason or another, he added, the epidemic has hit Massachusetts and other New England states particularly hard. Moreover, the high street values increase the potential for diversion here in the commonwealth.
“A lot of factors are involved,” he said.
Dr. Richard Pavao, chief of the division of pain medicine at UMass, which has an interventional pain clinic, said UMass began to take the initiative to focus on non-opioid management for chronic pain at about the time he joined UMass in 2010.
UMass aims to focus most of its evaluations and recommendations in a
comprehensive fashion, listening to the patient’s symptoms, performing a
physical exam and any required diagnostic tests, he said. This is to
hone in on a diagnosis and embark on a multifaceted approach to manage
pain without a focus on opiates, he said.
Those “puzzle pieces,” the UMass doctor said, include physical therapy, massage, chiropractic and anti-inflammatory injections. In some cases, even counseling is needed for chronic pain, he said.
Dr. Katherine Mason, who co-directs Harrington Hospital’s pain clinic, said the facility has been trying to take CDC advisories on prescribing opiates very seriously and tries to minimize the use of opiates for chronic non-cancer related pain and, like the other hospitals, focus on to non-opiate interventional therapies for chronic pain.
A Harrington spokesperson said that trying to steer patients away from pill-dependency has, of course, prompted some patients to turn in anger and relocate to a different healthcare system altogether.
Harrington honors transfer requests, but at the same time, it wants to retrain the community that it’s not a “medication management” clinic for pain.
Said Dr. Mason: “For patients who have been on opiates for a long time, it is really a struggle for them to get off of opioid-based medication, and we have been met with some resistance.” She said some patients are receptive to the hospital’s explanation of the adverse side effects and safety consideration with regard to long-term opioid use.
“We’re not afraid to use opioids for the appropriate situations and the appropriate patients,” she said. “But at the same time I think that those situations and those patients are far and few between.
Aware of opiates’ potentially addictive pull, Mr. Hallen said he got off of his prescribed painkillers immediately. He said he didn’t want to become an addict and enjoys being able to look his three young children in the eye.
Mr. Hallen subsequently tried cortisone injections and various other options, but his most recent minimally invasive procedure resulted in him leaving St. Vincent Hospital in Worcester “laughing my butt off.”
Mr. Hallen said his physician, Dr. Shawn Kumar, provided him relief by literally burning his nerve endings, through a procedure called radiofrequency neuroablation. It was performed Friday.
Mr. Hallen said he feels so good he doesn’t even have to take ibuprofen anymore.
“Hands down, this is the only avenue I could’ve went, other than surgery at 35,” Mr. Hallen said.
Pain is the most common reason for office visits to physicians across the United States, accounting for 20 percent of outpatient office visits and a total annual cost of health care of approximately $635 billion. In addition to medical costs, the amount includes economic costs related to disability days, lost wages and productivity, according to an Institute of Medicine Report from the Committee on Advancing Pain Research Care and Education.
At the same time, Massachusetts providers have been issuing fewer opioid prescriptions in the wake of the crisis. A state Department of Public Health report last year said about 638,000 Schedule II opioid prescriptions were issued in the second quarter of 2017, representing a 28 percent reduction compared with the first quarter of 2015.
Dr. Kumar said he hardly ever prescribes opioid use long-term.
In general, there has been a shift in the pain-treatment paradigm because of advances in the field.
Previously, he said, prescription opioids had been viewed as a viable alternative to undergoing a procedure for pain management, said Dr. Kumar, who previously worked at Rush University in Chicago.
“There’s certainly still a place for opiates,” he said. “There are patients that have tried everything and nothing else works. There are cancer patients. There are appropriate uses of opiates.”
But the premise of using opioids long-term, in the same way they’re prescribed for short-term pain management, has been somewhat debunked, Dr. Kumar said.
Also, there are a host of more invasive procedures, such as spinal cord stimulations, that are good at controlling pain without using medications, he said. It delivers low-voltage electrical stimulation to the dorsal columns of the spinal cord to inhibit or mask the sensation of pain.
In the early 2000s, Dr. Kumar said, governing bodies mandated that pain control be prioritized as the “fifth vital sign” and be treated more aggressively. This ultimately led to more patients being exposed to opioids, the doctor said.
At that time it was not entirely clear how addictive opiates might be, and this in combination to a cultural shift led to people’s increased willingness to abuse them. An aging population has also contributed to the crisis, the doctor said.
And for some reason or another, he added, the epidemic has hit Massachusetts and other New England states particularly hard. Moreover, the high street values increase the potential for diversion here in the commonwealth.
“A lot of factors are involved,” he said.
Dr. Richard Pavao, chief of the division of pain medicine at UMass, which has an interventional pain clinic, said UMass began to take the initiative to focus on non-opioid management for chronic pain at about the time he joined UMass in 2010.
Those “puzzle pieces,” the UMass doctor said, include physical therapy, massage, chiropractic and anti-inflammatory injections. In some cases, even counseling is needed for chronic pain, he said.
Dr. Katherine Mason, who co-directs Harrington Hospital’s pain clinic, said the facility has been trying to take CDC advisories on prescribing opiates very seriously and tries to minimize the use of opiates for chronic non-cancer related pain and, like the other hospitals, focus on to non-opiate interventional therapies for chronic pain.
A Harrington spokesperson said that trying to steer patients away from pill-dependency has, of course, prompted some patients to turn in anger and relocate to a different healthcare system altogether.
Harrington honors transfer requests, but at the same time, it wants to retrain the community that it’s not a “medication management” clinic for pain.
Said Dr. Mason: “For patients who have been on opiates for a long time, it is really a struggle for them to get off of opioid-based medication, and we have been met with some resistance.” She said some patients are receptive to the hospital’s explanation of the adverse side effects and safety consideration with regard to long-term opioid use.
“We’re not afraid to use opioids for the appropriate situations and the appropriate patients,” she said. “But at the same time I think that those situations and those patients are far and few between.
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