4 Points on Medication Management for Back PainWritten by Laura Miller | April 18, 2011
Jeffrey Wasserman, MD, a pain management physician with Pinnacle Pain Management in Dallas, discusses the role of pain management physicians in managing medication for back pain patients.
1. Simplifying medications. Physicians sometimes prescribe several medications to reduce pain that interact adversely. Pain management physicians can assist in medication management by making essential changes to improve efficacy. "If we can simplify or change the patient's regimen of pain medications, or switch medications to be more specific for a given type of pain, we often get better results," says Dr. Wasserman. "Additionally, if surgery isn't an option but the patient still has chronic pain, pain management physicians might prescribe long-acting opiates or use advanced pain therapies including spinal cord stimulation or implanted pumps."
2. Reducing overdose. Some patients with back pain abuse their prescriptions medications or divert them for profit or to assist family members or friends. "Experienced pain physicians are more likely to identify abuse and diversion and can reduce this risk to the individual and society." Patient questionnaires, review of pharmacy and clinic medication logs and urine toxicology tests are additional methods we employ to confirm patients use their medications appropriately, says Dr. Wasserman.
3. Pain pumps. For patients with severe pain, implanting pain pumps that continuously inject opiates into the patient's spinal fluid is an option. "Opiates injected directly into spinal fluid are 300 times more potent than the medication given orally, and has fewer side effects because it goes right where the drugs actually work and not throughout the body," says Dr. Wasserman. "But implanting a device long-term inside the body is not without risks." In the future, he predicts the development of more sophisticated and smaller implants will result in fewer complications associated with the procedures, and the implant will be less cumbersome for the patient.
4. Decreasing dependence on medication. Pain management physicians may also be able to reduce back pain by implanting a spinal cord stimulator system that reduces pain by blocking its transmission directly at the spinal cord. this may also decrease the patient's dependency on pain medications". Spinal cord stimulator electrodes are placed directly into a patient's spinal column in a relatively simple outpatient procedure to control pain. Hospitalization is very rarely required for this procedure and most patients are able to return to work within a few days. "If I can reduce medication use with spinal cord stimulators, the patients often get back to work and they don't have to pay for as many physician visits and prescriptions every month," says Dr. Wasserman. The reduction in medications, medical office visits, and reductions in lost work days can lower the overall cost of care.
Learn more about Dr. Jeffrey Wasserman.
Read other coverage on spine pain management:
- 6 Questions on Whether ACOs Will Assist Pain Management
- 4 Things to Know About Targeted Endoscopic Decompression
- Percutaneous Decompression Procedure Shows Promise for Lumbar Spinal Stenosis Patients
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