Management of Chronic Pain

Since graduating from PA school in 2000 I have had the privilege to work in multiple disciplines, including endocrinology and internal medication. However, trying to appropriately and effectively treat the chronic pain patient presents a very unique type of challenge. I spent several years managing these patients with medications, therapy and interventional injections in private practice prior to joining the BHOPB family in 2011. Even though the use of narcotic medications is not utilized in our current setting, it does not mean we are without the ability to effectively treat the substance use disorder (SUD) patient who has concurrent chronic pain. In my experience, when dealing with SUD patients the most important tool is communication. Patient’s want their medical providers to listen to their complaints and concerns. Contrary to popular belief, most of the patient’s we manage at BHOPB want to come off their medications by the time they make the decision to come for inpatient treatment. They recognize that the medications have stopped working for the most part and they are only continuing to abuse them ” just to feel normal” or “just so I can get out of bed.”

Here at BHOPB, we employ the appropriate multi-disciplinary approach for our chronic pain patients. This includes not only appropriate medication management but also referral for physical re-conditioning with a certified trainer, non-invasive modalities such as acupuncture and massage therapy and access to psychiatric specialists to address the reactive depression that we find co-occurring in these patients. In our experience, any approach that does not address both the physical and mental components of chronic pain does not work.

As a whole, we also spend quite a bit of time discussing the effects of long term opiate use on the brain, and how this can lead to a lowered pain threshold and increased sensitivity to otherwise non-significant pain ( hyperalgesia and allodynia). The take-home message we hope they hear is “time takes time.” In other words, patients are encouraged to give the process time to work while also providing them with realistic expectations.

The majority of our patient’s report more than 50% reduction of their pain from baseline from admission) during their treatment time; however, even more importantly, patient’s gain the confidence of knowing they can function normally without the use of pain medications.