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14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

The Future of Pain Management

Industry experts Jianguo Cheng, Stefan Evers, W. Clay Jackson, Lynn Kohan, William Maixner, Paula Marchetta, and more share their visions.
Pages 25-33
Page 5 of 6

Nothing in life is all or nothing, including the use of controlled substances. The use of non-pharmacologic, multimodal interventions is essential and, in 5 years, I believe we’ll have better evidence to guide practitioners in selecting these modalities. Providers will no longer be uncomfortable having difficult conversations with patients about the appropriate use of controlled substances, and they will have honest and open communication with patients, and other providers.

Pain management should be included in every professional curriculum—medical, nursing, pharmacy, and others. With more than 100 million Americans experiencing pain, it’s unlikely that this field is going to go away. Predicting regulatory expectations, on the other hand, may require the use of a Magic 8 ball! My hope is that we can find our way through the heightened regulatory scrutiny and work together (ie, clinicians, those who promulgate regulatory expectations, and law enforcement) to provide safe and effective pain management that safeguards the best interests in individual patients and society as a whole.

Srinivas R. Nalamachu, MD
Mid America PolyClinic, KS

In light of all the new regulations from the state and federal governments, we are facing a lot more hurdles with patient care in treating chronic pain—hurdles that I hope our profession will overcome in the next decade. For instance, while a majority of PCPs do not want to prescribe opioids for the management of chronic pain anymore, there are not enough pain clinics that are willing to fill the gap. In addition, a great majority of patients referred to pain clinics are co-prescribed benzodiazepines, sometimes for no apparent reason. This has become a challenge as those patients are at a much higher risk for adverse events and it is a difficult process to wean patients off of these medications.

At the same time, insurance companies are trying to limit the dose of opioids, quoting the CDC guideline as an excuse. Large chain pharmacies are coming up with their own policies that limit or decline the number of pills that can be prescribed, placing undue burden on the clinic staff to communicate with pharmacies repeatedly.

In addition, as more states liberalize the tetrahydrocannabinol usage for medical and/or recreational purposes, clinicians are struggling to accommodate patients’ requests. We are more concerned than ever about patients’ safety when they take opioids and marijuana together. As these rules and regulations become more complex, patients may be left at a loss.

Kern A. Olson, PhD
Pain Psychologist, Portland, OR

The role of pain psychologists has been evolving over the past decade and now is the time to become more assertive in patient selection and assessment.

First, our physician providers need to appreciate and welcome psychological input before performing elective surgery and prescribing opioid pain medicine. It makes common sense that one would want to know whether there are risk factors that could influence favorable outcomes.

My advice to pain psychologists is to assume the role of physician extender and assure the referring physician you are there to help. A recent survey of medical schools in the US asked how much time in 4 years of medical school is devoted to the issue of pain. The answer was 1 hour, and since this is an average, my guess is that some schools spend no time on the study of pain. Yet, pain is still the number one reason individuals go to the doctor. I hope my physician friends will lobby their medical schools to correct this issue.

Elmer G. Pinzon, MD, MPH, DABIPP
University Spine and Sports Specialists, Knoxville, TN

Patient assessment is likely to evolve through the use of new diagnostics and methods that are connected to information technology and the multimedia sources available in our offices and homes. For instance, provider-patient communication may transform into more web and TV-based options, including educational opportunities for both providers and patients.

Some older—and some newer—approaches to managing pain will become more prominent, including the use of alternative medicine options, nutraceuticals, non-narcotic medications, durable medical equipment, acupuncture, and fitness methods. Due to regulatory changes, our practice strategy and operations will continue to evolve to place more emphasis on interventional, musculoskeletal pain management techniques and less emphasis on narcotic-based techniques.

To help control our physician burnout epidemic, I can only hope that our regulatory community will place new measures on controlling the time-consumption of electronic health records.

C. Norman Shealy, MD, PhD
International Institute of Holistic Medicine, Fairgrove, MO

Pain management expanded in the 1960s with electrotherapy and biofeedback. In the 1990s, unfortunately, the expansion was with opioids and mood-altering drugs, which created far worse problems. Now, we are on the threshold of major improvements to reduce physiologic stress and narcotic addiction. Refinements in electrotherapy are likely to include pulsed electromagnetic frequency, which has become more popular and effective than transcutaneous electrical nerve stimulation; Sapphire enhanced Scalar may be equally beneficial as it reduces all biochemical reactions to stress.

Joseph Shurman, MD
Pain Management/Palliative Care, Scripps Memorial Hospital

If one believes in cycles, pain management has been in a downcycle since the year 2000. With the reversing of the aging population and approximately 50% of patients over age 50 experiencing chronic pain, we are due for an upward turn. On the positive side, the AMA recently came through with a very critical article of the CDC guideline on opioid prescribing and how it is being used in medical board reviews, hospital privileges, etc. New technologies are being developed to deal with the overdose issue. Some countries, including Canada, have established injection sites where patients on heroin/fentanyl or other opioids can go and be maintained until they can be placed in an appropriate addiction center; they appear to be getting good results. There is a desperate need for centers and specialists in the US that accept insurance/Medicare to see pain patients with OUD or who just want help to get off opioids. If they rise to the occasion and these trends continue positively, pain patients will rise both politically and through the media.

Last updated on: February 20, 2019
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