Pain Management Is Changing, But Is It for the Better?

A recent experience made me realize that pain management is changing.

I recently assisted a family member who was experiencing severe back pain that prevented her from walking. The pain became so severe that she took an ambulance to the emergency room (ER) early one Saturday morning when I was out of town.

She received treatment at the ER for her pain, but she wasn’t sent home with any pain medication. The following Monday, I took her back to the ER for follow-up treatment, and an MRI showed disk bulging on both sides. That helped explain the pain and resulted in discharge with a prescription, but for only 20 doses of an opioid. The pills did provide some relief, but she visited her family physician several days later because she needed more to control her pain.

She received another prescription for 30 doses and a referral to an orthopedist in the spine center for follow up a few days later. She left that visit with a more precise diagnosis and a prescription for 2 weeks’ worth of opioid treatment. However, the family physician told her to be careful with the narcotic, as the MD wouldn’t prescribe it again.

Anyone who looked at my family member’s medical record might believe she was a drug abuser seeking narcotics because she had been to multiple providers for pain medication when, in reality, she was seeking relief for real pain.

When I started practicing pharmacy many years ago, prescribers feared that opioids were addictive, so they prescribed them reluctantly. As a result, patients like my family member were often denied real pain relief, which is why there was an effort in the 1970s to make pain another vital sign and make pain management a skill that prescribers developed.

Today, we continue to hear stories about individuals getting addicted to pain medicine as a result of legitimate treatment. The result seems to be what my family member experienced: real reluctance to treat legitimate pain and real concern about patients becoming addicts.

In the end, my family member was able to get pain relief, but it took a few more visits than what may have been necessary, potentially costing the system more money. However, along the way, she realized that she shouldn’t depend on opioids, but instead work to get her problem resolved with exercise and other treatments. To me, that seems like a good balance between overreliance on opioids and undertreatment.

A recent New York Times article described how a New Jersey ER attempts a full range of options to curb addiction. It made the point that too often, those in emergency medicine reflexively prescribe opioids because it’s an easy way to get patients out of the ER and take care of those next in line. My recent experience tells me patients in need of opioid treatment are getting it, but not as conveniently as before. Isn’t that better in the long run?