Quit Giving Pain Meds
Physical Dependence and Addiction are part of the same coin as Pain Management. This is a specialty that has no time for primary care. I almost regret opening articles regarding my field of Pain & Addition Medicine because I inevitably read comments from my fellow physicians, even our governments politics, when I’m obliged to show respect when, in fact, I’m offended by the lack of knowledge being pompously presented with such authority.
I’m an anesthesiologist interventionalist and believe in surgery where indicated. Depending on the surgical procedure, annual fail rates are very low BUT PRESENT. And let us not forget about the risks of anesthesia, infection, and all the other associated morbidities, even mortality. Surgery is not benign. It is invasive and sets the patient on a road to more surgery when there are failures.
What are we trying to accomplish with these patients? Our goal should be to increase functionality, quality of life, and prevent suffering. Logically our interventions should start out at the least possible level of intervention then, as indicated, progress to the next lowest level of intervention. Once we reach the level of surgery we have no other options except more surgery. Obviously we should try every treatment modality available prior to surgery. With this approach we offer the patient options to support their choice to have surgery, i.e. informed consent. At the least, we lessen the chances of missed diagnosis, increase the chances of an effective surgery, delay the last ditch effort of surgery, and decrease the incidence of opiate dependence with all of its attendant risks.
Our Hippocratic Oath starts off with us physicians respecting those scientists that came before us and gave us our evidence-based knowledge. It goes on to say that we will share that knowledge with those physicians that follow us; this is what I’m doing here. I may wonder about alternative medical approaches but I never prescribe them. To me, alternative medicine is voodoo until it is proven otherwise. The dollar bill says “In God We Trust”, but as far as I’m concerned, the rest of you give me data. And the data exists. It is easy to find, just Google it. Note, the very next part of our Hippocratic Oath basically says “avoid overtreatment and therapeutic nihilism”.
The evidence is very clear, GET IT: All physicians, regardless of their discipline, should not prescribe any form of narcotic for more than a few weeks without having the resources, and time, to safely and effectively treat their patient’s pain and medications. The most effective way, by far, that this can be accomplished is with an integrated multidisciplinary approach that includes injections, non-opiate meds, narcotic management, physical therapy, and behavioral therapy. If you can’t do this in an integrated fashion then you should not be prescribing narcotics for more than a few weeks. Quit with all this nonsense. Every “pain” fellowship, every literature review over the last 30 yrs to include the recently published CA Div. WC Medical Treatment Guidelines, the “National Pain Strategy” from the US Dept. of Health and Human Services, the US Centers for Disease Control & Prevention “Opiate Guidelines” all say the same thing; Refer the patients you have within weeks if you do not have the resources to provide an integrated multidisciplinary approach. Scientifically proven, not opinion, just fact, period!
What part of this don’t you get?
About the Author:
Robert Kutzner, M.D. is an Addiction Medicine & Pain Management Physician at MD Health Clinics located in Orange County, California. Here’s a video featuring Dr. Kutzner speaking at the Joint Forum to Promote Appropriate Prescribing and Dispensing. You can view more on MD Health Clinics YouTube Channel.