Improving Quality of Life within the Alabama Pain Management Act
You’ve heard the news stories before. Sadly, they sound so much the same. Michael Jackson, Elvis Presley, Whitney Houston—again and again, a celebrity death involving prescription pain medication makes news. What doesn’t grab as many headlines are the thousands of other deaths of people who weren’t celebrities to anyone but their families or friends. They lost their battle with pain when they combined too many drugs and died from either organ damage or an overdose.
According to the CDC, Alabama is among the top 20 states in deaths from prescription drugs. To combat the problem of multiple drugs from numerous sources and doctor shopping to acquire more, recent legislation has established requirements for registration of providers, tracking of prescriptions, and testing of patients to verify that the medications meant to ease suffering aren’t being combined into a potentially lethal cocktail.
“Managing pain that continues beyond the acute phase and doing the follow up required under the Alabama Pain Management act can be time consuming,” Nitin Chhabra, MD of the Birmingham Pain Center said. “There is a trend toward shifting pain management to specialists who are equipped to deal not only with the additional testing and tracking, but also to treat chronic pain with multiple modalities that can be tailored to each patient. We work closely with the referring physician in these cases.”
The Alabama Pain Management Act requires that all physicians who provide pain management services register with the Board of Medical Examiners. When drugs are prescribed for the management of chronic pain, it also requires close monitoring and follow-up.
“As registered pain physicians, we have access to a database we can check before we prescribe to make sure the patient doesn’t already have a prescription from another source for a medication that might be a problem,” Chhabra said. “In some cases, a patient may be doctor shopping for a drug, seeking the euphoria, or they may have developed a tolerance and think they need more. Often, however, the potential problems we see are from combining drugs that may interact or increase the impact of a medication. Patients may not realize that combining a pain medication with a sleeping aid and an antidepressant or other drugs may overburden their organs and put them at risk.”
Another reason for testing is to make sure the patient isn’t consuming other substances that could create a danger.
“When a patient is taking medications that shouldn’t be mixed with alcohol, recreational drugs or over the counter drugs, we test for compliance to make sure there aren’t any safety issues that need to be addressed,” Chhabra said.
Fortunately, there is a wide choice of medications, treatments and other measures that can be tailored to each patient to make life with pain more livable.
“There’s more focus now in treating chronic pain on multiple fronts through other receptors of pain. In some cases, we might use interventional procedures, a variety of non-opiate medications, physical therapy, biofeedback, and coping tools like relaxation. Often, there’s a psychological component, which is why we have a psychologist on staff. Sometimes stress, anxiety and depression are preexisting, but being in pain for an extended period, and dealing with the limitations it causes can exacerbate pain. Managing the psychological effects helps in managing the physical pain,” Chhabra said
To prevent acute pain from becoming chronic, there is more emphasis now on treating pain early and effectively.
“For example, in surgery cases, many anesthesiologists are using multi-modal anesthesia to block pain impulses in different areas. Neurotonin or Lyrica and antiinflammatories are being used immediately after surgery as a preventive measure so pain is less likely to become a long-term issue. When pain doesn’t resolve as it should, physicians are sending patients to us as soon as possible to find out why,” Chhabra said.
In many cases, pain can be managed without the need for opiates. However, there are situations where opiates may be necessary to bring relief. Some patients may be reluctant to take them because they fear becoming addicted.
“There is a lot of confusion between addiction and dependence. Addiction comes from seeking euphoria and pleasure from opiates. Dependence can occur when opiates are necessary to cope with pain,” Chhabra said.
“A problem with opiates is that with tolerance, they can become less effective over time. Medications may need to be adjusted. Hyperalgesia can also develop so that patients who have been on opiates for an extended period may have an exaggerated response to pain and feel it more intensely.
“That’s why we focus on finding the right combination of other medications and using interventional procedures if needed, plus other measures to help our patients live more comfortably.
