Managing chronic pain takes time and more than just prescribing pain meds, especially since the rates of accidental overdoses leading to ER visits, hospitalizations and death have skyrocketed. Did you know that more Americans have died from opiate overdoses in the last 15 years than all the soldiers killed in World War II, the Korean and Vietnam wars? Accidental overdoses frequently occur when opiates are mixed with alcohol, sleeping medications, anxiety and depression medications, marijuana or antihistamines.
Washington State has taken the lead in formulating treatment protocols to follow. These protocols protect and help lead patients to better or safer treatments and protect the practitioner from charges of mishandling opiate prescriptions. I follow those protocols and more.
In case one does not think this is an issue, a major pain clinic with offices all over western Washington was recently disciplined for over prescribing and may leave up to 25,000 patients scrambling for someone to manage their chronic pain.
Here’s a good example: a woman came to me with chronic headaches, neck and shoulder pain. When informed that sedatives increase the risk for overdose, she stopped them. Death from accidental overdose occurs if opiates or sedatives suddenly shut down the lungs or the heart. Her circulation, kidneys and metabolic tests were abnormal and she started treatment to prevent these problems. She was diagnosed with migraines when she actually has occipital neuralgia (nerve irritation), which improved with one injection of Novocaine and B12. B12 injections have anti- inflammatory and nerve tonic effects. Together, we found she has trigger points throughout her neck. B12 injections have substantially improved her headaches, neck and back pain, shoulder pain and elbow pains. She was not aware that she was at maximum opiate doses with high risks for side effects, including sudden death. We have reduced her doses, educated her of symptoms requiring emergency treatments and prescribed naltrexone for emergency use if overdose symptoms occur. Her pain problems are improving, step by step.
Another patient came to me on extremely high doses of oxycodone When she learned she was at risk for side effects (death, blunted brain functions, blood sugar or hormone problems and more) she reduced her opiates by 50% with no withdrawal symptoms or increase in pain. Next, neurocognitive testing showed impaired brain functioning, depression and PTSD (post-traumatic stress disorder). Testing also showed blood sugar imbalances and low estrogen. She started an anti-depressant and her mood and pain improved. We reduced her opiates a little more. She started estrogen treatments, mood improved and we reduced her opiates a little more. She got a FIT BIT to track calories, weight and activity levels and noted improved mood and pain, so we decreased her opiates a little more. She is now at a safer level of opiates with more effective control of pain and increased quality of life.
If you know any with chronic pain, encourage them to find a clinician who can reduce reliance on opiates and decrease risks and side effects.
David Overton, PA-C works at Natural Medicines combining conventional and alternative treatments under the supervision of Dr. Richard Faiola, MD, ABFM.