Morton: Better Pain Care Is Possible, Without Increasing Risk
Tuesday, October 31, 2017 | 798 | 0 | min read
There are a lot of important conversations happening surrounding the challenges of caring for the nation’s injured. One of the biggest challenges we face is opioids, and the challenge can be distilled down to the following points:
- Pain is a serious health matter.
- Injured workers need to be treated fully so they can get their lives back.
- Opioids are a useful and medically appropriate way to treat pain as part of a comprehensive pain care plan.
- Opioids can be addictive.
- The chronic pain and opioid epidemics are intertwined.
The good news is that as a society, we are coming together to research and test out solutions to comprehensive pain care without exacerbating the opioid epidemic. As a premier workers’ compensation pharmacy, we believe in the following principles that underlie such solutions:
- Pain is complex. It has psychological as well as physical dimensions. We support swift and aggressive treatment for acute pain. Without it, acute pain can become chronic pain. And chronic pain is a key risk factor for opioid abuse.
- Opioids are just one treatment option for pain. The National Academies of Sciences, Engineering and Medicine have recently called for, among other things, insurance reimbursement for comprehensive pain care. We support that call. To us, comprehensive pain care means using non-opioid pharmacologic treatments when possible, including muscle relaxers, anti-convulsants, anti-depressants, patches, ointments, creams and compounded medications.
We also need to treat the whole person and more frequently employ drugless pain treatments such as osteopathic/chiropractic manipulative care, physical therapy, cognitive behavioral therapy, acupuncture and massage.
But under a doctor’s supervision, and in the right circumstances, opioids can be the right call.
That’s why the academies advise against arbitrary opioid restrictions that could jeopardize suffering patients whose health care providers have responsibly prescribed these medications. We support the academies’ position.
Opioids are not a doctor problem per se. Although doctors need better training, in med school and in mid-career, opioids are truly a societal problem. Everyone has an important role, including providers, patients, families, pharmacies, drug companies, payers, government agencies, state agencies, educators and medical societies.
Pharmacies have an important role. They should be prepared to have discussions with providers about opioid dosing and the possible need for naloxone (overdose-reversal) care.
Payers have an important role. They should be prepared to reimburse for comprehensive pain care without placing undue obstacles in front of the patient receiving doctor-prescribed care.
Patients and families have an important role. They need to be realistic about the goals of treatment and the limits of treatment. They also need to learn recognize signs and symptoms of opioid use disorder in their loved ones.
Drug companies have a role. They need to continue development of less-abusable medication formats, e.g., tablets that can’t be crushed and snorted. They must also practice safe and responsible marketing of their product.
The Drug Enforcement Agency has a role. It needs to better manage the volumes and distribution protocols of opioids.
Academia has a role. Aggressive research is needed to better understand pain and how to manage it more effectively.
Doctors, though not the problem, are ground zero. We support the CDC’s prescribing guidelines of 2016, which stress realistic comprehensive care to those in chronic pain, prescribing appropriately, and using treatment tools such as prescription drug monitoring and urine drug testing to guide therapeutic decisions.
With everyone adopting these principles and working together, we can continue to make strides in improving the care of our injured and sick workers. Nothing is more important than helping these individuals get their lives back.
Dr. Joel Morton is medical director of Summit Pharmacy Inc. in Phoenix. This column is published with permission.