Page 8 - FOCUS December 2017

COVER STORY
RETHINKING PAIN MANAGEMENT
In his 2016 letter to physicians, U.S. Surgeon General Vivek H. Murthy, M.D., MBA, asked them to do three things to address the opioid crisis. In addition to pursuing evidence-based treatment and seeing addiction as a chronic illness, he asked providers to educate themselves about how to treat pain safely and effectively.
Irina Phillips, M.D., medical director of Christiana Care’s pain consult service, said providers were encouraged in the 1990s to treat pain aggressively. Early studies, though limited in scope, suggested opioids were safe for long-term use even in those without cancer.
“What began with good intentions led us into this difficult situation,” Dr. Phillips said.
Now, she’s working with complex cases at Christiana Hospital, including patients on opioid therapy for chronic conditions. Other cases include patients whose conditions make them vulnerable to the sedating effect of opioids and patients for
“The very thing they think is going to make them better we know won’t make them better.
“A lot of patients don’t want to be on chronic opioids but can’t imagine any other way.” IrinaPhillips,M.D.
whom the illicit use of injected drugs has led to consequences such as infections of the spine and heart.
“Most patients requesting opioid medication just want to feel better,” she said. Unfortunately, there is not solid evidence that long-term opioid therapy is effective. As patients build tolerance to the drugs, higher doses are required, which can be punishing to patients’ ability to function.
“The very thing they think is going to make them better we know won’t make them better,” she said. “A lot of patients don’t want to be on chronic opioids but can’t imagine any other way.”
Instead, Dr. Phillips pursues a multimodal pain strategy that may include non-opioid pain medications as well epidurals or nerve blocks. More often, medication is not the best solution, especially for the most common types of pain in the back and neck.
“For chronic back pain, we know the best relief is physical therapy and daily exercise,” she said. | CONTINUED
8 • FOCUS DECEMBER 2017