Providers turn cautious on painkillers

• The dramatic increase in opioid addiction has changed the ways providers treat patients’ pain
• Providers no longer routinely prescribe painkillers
• Treatments that don’t involve opioids are more effective than you might think

Health care providers in the United States have turned 180 degrees in the ways they approach a patient in chronic pain.

For years, they routinely prescribed pain-killing medications known as opioids, including such brand names as OxyContin and Vicodin, and the generic drug fentanyl. 

The drugs were effective at bringing pain under control, but with many individuals, these pain killers had other, more subtle and seriously damaging effects. Many people who used the drugs to combat pain found themselves unable to quit using them. Some became addicts, even crossing over to take illicit opioids such as heroin.

Addiction destroys lives and kills many addicts -- about 116 each day in 2016, according to the Department of Health and Human Services. President Trump last fall declared the nation to be in the grips of a public health crisis, ordering the agency to issue grants, launch an awareness campaign and take other steps intended to treat those addicted to opioids. 

For health care providers managing patient pain, the shift in thinking about opioids has caused them to look for alternate ways to treat patients suffering from pain.

“We’re trying to look at ways to treat pain outside opioids,” says Robert J. Klem, MD, MHA, Swedish regional medical director for primary care and a primary care physician at Swedish Richmond Beach Primary Care. Providers increasingly view the body and mind as an integrated system, meaning some symptoms of pain may be handled with non-medicinal therapies, from counseling to exercise.

Opioids remain appropriate for some patients suffering certain diseases, such as rheumatoid arthritis or cancer. In such cases, Dr. Klem says, opioids respond to the dysfunction of the nervous system caused by the diseases.

But providers generally give careful consideration to prescribing painkillers, weighing such risk factors as addiction histories and pulmonary and cardiac conditions, he says. 

To better help patients understand and participate in the management of their pain, Swedish has developed the STOMP guide. The acronym stands loosely for Structuring Your Own Management of Pain. Chapters address sleep and pain, ways to calm the nervous system without drugs, and even a chapter on hobbies and relationships.

“Chronic pain is much more complex than acute pain and the mind plays a large role in how this pain is experienced,” the guide explains. “However, most current treatment methods still rely on biotechnological treatments such as medications, injections, ablations and surgery. Unfortunately, research has shown that these methods are not particularly useful in reducing chronic pain.”

Dr. Klem says treatments that don’t involve opioids are more effective than you might think. For example ibuprofen, sold without a prescription in pharmacies and grocery stores, “is a good fever reducer.” A person who experiences pain in his foot or heel may be as well served by a good pair of orthotics as by a drug. And when pain leads a patient to become anxious, psychiatric counseling may be more appropriate than medication.

Since Dr. Klem’s years of residency in the 1990s, he says, “we’ve come full circle with pain management.”
If you’re experiencing chronic pain, discuss it with your health care provider. If you would like to discuss it with a Swedish pain medicine provider, you can find one in our online directory.

Ask the doc: Treating pain after an injury

You spend the weekend on a ladder, rolling paint across the ceilings of three rooms. On Monday, your shoulder is killing you. What should you do?

Pain is your body’s response to overuse, misuse or acute injury. It tells you that your system is stressed and needs to heal. In other words, it’s routine and nothing particularly to worry about.

“To a certain degree, pain is a normal part of life,” says Dr. Klem. “It serves a purpose. If you hit your thumb with a hammer, pain tells you ‘Don’t do that.’”

Often rest and an over-the-counter pain reliever, such as ibuprofen, is all you need.

But if the pain persists, you may start wondering: Should a doctor look at this?

“If the pain lasts longer than should reasonably be expected, it should have some attention,” says Dr. Klem.

What’s longer than expected?

“It’s kind of arbitrary to define a time frame,” he says. Depending on the injury, “it could be days, could be weeks or could be months.”

If an injury continues to hurt and be uncomfortable longer than you would reasonably expect, then by all means head to a Swedish Express Care clinic, urgent care clinic or the office of your primary health provider. 

For pain that is chronic, as opposed to the acute pain you experience after a weekend of painting ceilings or hammering nails, then you should absolutely see a provider, Dr. Klem says. 

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.