Chronic Pain 101 Evidence Based Medicine
Chronic Pain 101 was the next topic at the conference.
Dr. Nemeth ([email protected]) with RestoreFx was the prior Medical Director for the TDI – State of Texas. He is from Austin, TX. He is going to talk about medication misuse.
- Abuse – Addiction is a brain disease with loss of control, compulsive use, craving, and consequences.
- Tolerance – the state of physical adaption in which exposure to a drug induces changes that result in decreases of drug effect over time
- Hyperalgesia- a state of hypersensitivity following the withdrawal or of opioids or in chronic addiction
- Pseudoaddiction – drug seeking due to the undertreatment of chronic pain
- Copers – tolerate the pain
- Chronic pain syndrome
- Up to 56% of Pain Clinic patients
- Family History of Addiction
- Behavioral indicators
- Urine Drug Screening
- Medical Indicators
TAKEAWAY – CHRONIC PAIN – ADDICTION IS A BRAIN DISEASE
ODG- National Guidelines- prescribing guidelines that are now accepted in the 13 states.
- Evidence based
- Cost-effective in most cases
- Autoimmune disease
- Numerous other conditions
- Other care – e.g. urine drug screens
- Compounded drugs
- Underlying comorbidity
- Treatment plan issues
- Have a plan
- Get a team
- Who will first contact provider?
- Type of info
- Options to offer
- Interventional techniques increased by 228% – 2000 to 2011
- Medicare expenditures increased by 240% – 2000 to 2008
- Office of Inspector General (DHHS) significant proportion of facet joint and ESI’s were not medically necessary.
- A single facet joint injection is recommended
- If 50% or more pain relief for 6 weeks from the single facet injection, proceed to other blocks
- Series of three injections is antiquated
- A Point of Care screen is recommended before initiating chronic opioid therapy
- Risk assessment should be made on a schedule determined by patient abuse risk factor
- Random collection is encouraged
- Quantitative testing is not recommended