By Mark Pew, Senior VP, Preferred Medical
This week I want to share a video and article about the subject of opioids and chronic pain treatment. The first is a video that showcases a small county in Minnesota and how they have approached prescribing opioids in a different way. The second is a draft report that recommends additional approaches to treating acute and chronic pain. Below you’ll find these resources and my thoughts on their implications.
What happens when you flip the script?
Douglas County, Minnesota only has a population of 36,000 people yet there are 30,000 opioid prescriptions. But recently, the state of Minnesota has changed their guidelines to help doctors like Dr. Paul Kietzmann see opioids differently. These new guidelines have helped educate medical professionals and draw a line early between when opioids are needed and when they are no longer being effective. Dr. Kietzmann and his practice learned they had been practicing unsafe dosing of opioids. Now, they work together with patients to manage pain in a safer way. This practice believes that the conversations around opioids have led to placing a higher importance on patient-centered care.
A worthy investment of less than four minutes. The epiphany for this physician and his colleagues in this relatively small county in Minnesota that had the 3rd highest per capita #opioid prescribing in the state were the treatment guidelines. There was an alternative for real pain management. The way forward was conversation, relationship and working together between prescriber and patient. In other words, common sense and the golden rule. Nowhere did he say that opioids were not part of his practice anymore (there was a decline of 43 percent —not 100 percent—in opioid prescriptions from 2017 to 2018), just that he was more educated about options. “The conversations about opioids has helped re-focus on patient-centered care”—nobody can sensibly argue that’s anything but a good change. The three principles for the opioid guidelines published in March 2018 (read the full guideline here) are:
- Prescribe the lowest effective dose and duration of opioid analgesia when an opioid is indicated for acute pain. Clinicians should reduce variation in opioid prescribing for acute pain.
- The post-acute pain period—up to 45 days following an acute event—is the critical timeframe to halt the progression to chronic opioid use. Clinicians should increase assessment of the biopsychosocial factors associated with opioid-related harm and chronic opioid use during this period.
- Chronic Pain—The evidence to support chronic opioid analgesic therapy for chronic pain is insufficient at this time, but the evidence of harm is clear. Providers should avoid initiating chronic opioid therapy and carefully manage patients who remain on opioid medication.
As with all of the other guidelines published by the federal government, state governments and private organizations, there is nothing that says “no opioids ever” but instead reiterates “be very careful.” And that was ultimately the epiphany this Minnesota physician needed to evaluate what he was doing and why.
Are there better ways to treat chronic pain?
Chronic pain is experienced by millions of people all over the world, and a lot of times it is treated with opioids. Recently, a draft report has been released that argues the best treatment for acute and chronic pain is to create an individual patient-centered approach. A few areas of focus for the treatment include evaluating patient medical, social and family history, alternative treatments, seeking help from more specialists and mental health support.
“This is short, simple and to the point. It does not go in depth rather lists what is believed to be needed in resolving the chronic pain epidemic we are now experiencing that has a large part in the current Opioid Crisis. Read the entire report.”
“Balanced, individual patient-centered approach” indeed! Of the nine items included, I especially appreciated “more education and training” because that speaks to the heart of the issue – better information will yield better choices.
To read everything on my mind this past week, please visit me on LinkedIn.
Disclaimer: The views and opinions expressed above are those of Mark Pew, and do not necessarily reflect the views of Preferred Medical.
About Mark Pew
Mark Pew, Senior Vice President of Product Development and Marketing for Preferred Medical, is a passionate educator and agitator. Known as the RxProfessor, Mark is focused on the intersection of chronic pain and appropriate treatment, particularly as it relates to the clinical and financial implications of prescription painkillers, non-pharma treatment modalities and the evolution of medical marijuana. He is a strong champion for the workers’ compensation industry to #PreventTheMess and #CleanUpTheMess, movements he created to drive attention to the importance of individualized appropriate treatment for injured workers. Mark is a vocal advocate of the BioPsychoSocialSpiritual treatment model.
Mark serves on the IAIABC’s Medical Issues Committee and SIIA’s Workers’ Compensation Committee. In addition, he serves as technical advisor to regulators and legislators in 20+ jurisdictions on subjects such as drug formularies, treatment guidelines, Opioid Task Force initiatives, encouraging support of non-pharma treatment options and the medicinal use of cannabis. Mark received the WorkCompCentral Magna Comp Laude award in 2016 and the IAIABC’s Samuel Gompers Award in 2017.