Kentucky Doc Spring 2016 - Page 21

doc Spring 2016 • Kentucky tion and titration to effect fails to address the underlying etiology of pain while marginalizing the motivation for change and rehabilitation. Once a patient bypasses the acute phase of opiate exposure, the physical dependency creates an impression that the pain is worse without opiates when in fact, the pain of withdrawl exaggerates the underlying cause of pain. After the pharmacologic duration of action, opiates have a rebound effect and thus magnify the pain experience when the medication has worn off. Once re-medicated, relief from the rebound pain gives the perception that only opiates can stave off pain. Patients remain in a vicious cycle with the notion that anything less than unrestricted opiate escalation is cruel. Insurers Payor models often have unintended consequences. In pain management, there are numerous examples that hinder effective care and promote strategies without proof of efficacy. Insurance reimbursement has long focused on compliance monitoring, radiologic diagnoses (often superseding skilled physical exam findings), urine toxicology, and invasive options including surgery and joint replacement. Low health literacy obstacles regarding pain often require more time with patients, a service that is not proportionately reimbursed. It is far easier and more lucrative to operate or write a script than to dissect the problem and educate the patient. As a result 21 patients may opt for options that are less effective and more costly to healthcare. Services often lacking in the repertoire of payers involve psychological, lifestyle counselling, rehabilitation, or regenerative options, all tools which have very strong track records of cost-efficacy. Pharmaceuticals In the short span of 20 years, opiates have become the most prescribed medication in the country, a boon to many pharmaceutical companies. Similar to strategies used by the tobacco industry, the risks and benefits of opiates were misrepresented. As a field, we trusted without verifying and many extrapolated claims trumped solid science in pain “Solutions start with accountability and it involves challenging long-believed myths about pain management.” – Dr. Mazloomdoost Continued on Next Page...