Our approach to opioids
At PCI, the physicians and staff are experts in relieving pain so people can return to living their lives. We develop treatment plans using the cornerstones of interventional pain techniques, physical therapy, and behavioral medicine. This statement of philosophy explains our approach to using opioids (sometimes referred to as narcotics, controlled substances, pain pills, pain patches or pain relievers) for the treatment of pain. An important characteristic of opioids is that they modify the experience of pain in the brain; they do not treat the underlying cause of the pain.
Low doses of opioids can reduce pain and improve life function; they can also cause decreases in function and, in some cases, increase pain. Research has shown that opioids are helpful only for a little over 6 months of continuous treatment before decreased effectiveness occurs. Tolerance to opioids is the diminished effectiveness of the same dose of medication over time. This can cause problems if other painful conditions develop because those future painful conditions may not respond to opioids; all patients on long-term opioids will develop tolerance. Dependence will also develop and once established, stopping the medication may result in diarrhea, nausea, muscle aches, and feeling poorly. Addiction is a psychological effect that occurs when a patient loses control over their use of the opioid medication and/or continues to use it in the face of personal harm.
Examples of addictive behavior include:
- using the medication other than as prescribed such as more often
- using medication from other than your pain management practitioner
- using illegal drugs or prescription medication from others
Addiction creeps up on many patients and they do not realize it. It starts, usually, with explanations about why more medication is needed but can quickly become a problem for a patient’s health, their loved ones, and the workplace. Daily dosing of opioids reinforce fear and avoidance of pain. Addiction makes patients vulnerable to pain, and daily usage of opioids creates reliance on something outside of oneself to cope with pain. As a result, patients become psychologically dependent upon the drug and the healthcare system that provides it.
PCI practitioners prescribe controlled substances as part of treatment plans that are based on individual needs and a legitimate medical purpose for these medications. We recognize that opioids play a role in the management of chronic pain but believe that more effective alternatives can be found for most patients. We believe that all possible treatments should be implemented prior to the long term treatment of chronic pain with opioids. Only if alternative treatment plans fail, will the use of opioids be considered.
If opioids are included in the treatment plan, it will be within the rigid structure that is the policy of PCI for the use of these medications and includes:
- Frequent medical evaluation based on need, including appropriate physical examinations, diagnostic testing, and drug testing;
- Participation in physical therapy and/or daily exercise regimens;
- Behavior/cognitive medicine treatments on a prescribed regular basis; smoking cessation programs, if indicated;
- Adherence to an opioid medication agreement.
Your First Visit
Your first visit to PCI will include a thorough medical history, physical examination, urine drug screening, depression screening, and formulation of a treatment plan which will be explained to you. If you are not interested in exploring alternatives to opioid medication for pain management, we may recommend that you seek care elsewhere. We may recommend trialing various options that have been tried at other pain clinics because we believe that our methods and techniques provide better outcomes. Prior treatments may have been ineffective for a variety of reasons and similar treatments by our expert practitioners may prove helpful. Many times your opioids may be reduced or discontinued with our approach.
PCI practitioners may or may not agree to prescribe opioid medications to you on your first visit. Most often, if we agree to do so, it will be for a short period of time of 30-60 days while we become familiar with your pain condition through repeat visits, examinations, diagnostic testing, physical therapy evaluation, and initial response to our non-opioid treatment plan. If you chose to not follow our treatment plan, we may decide not to prescribe your opioid medication into the future.
As medical professionals we have a duty and responsibility to formulate and manage a treatment plan that is appropriate medical care and that is consistent with our stated philosophy and policy. If you do not agree with our philosophy, please let us know and we will try to help you find another pain clinic to treat your pain.