Tuesday, July 17, 2012

The Pain of Prescribing Pankillers

Pain is a terrible thing, but you know that already. It can make life unbearable and for some, it does. Having once ruptured a disk in my back that pressed on my spine due to a foolish maneuver in a gym, I can imagine what experiencing incessant horrible pain truly means. My pain was so severe, I couldn't think, I couldn't sleep, I could hardly breathe. I was in horrible agony. I finally understood why a terminal cancer patient in such pain may want to call it quits. So, yes, I can emphasize with someone suffering from pain. Nevertheless, we have an epidemic of painkillers being prescribed here in the U.S. and often times it is inappropriate and unnecessary.

In fact, one of today's headlines in the NY Times titled, "Rise In Pill Abuse Forces New Look At U.S. Drug Fight." The first paragraph reads, "America’s drug problem is shifting from illicit substances like cocaine to abuse of prescription painkillers, a change that is forcing policy makers to re-examine the long and expensive strategy of trying to stop illegal drugs from entering the United States."

In the practice of medicine, one invariably is confronted by a patient seeking pain medication. I am stingy with such medication, not because I lack empathy for it's need, but because I want to make sure that it's really needed and I am not trading pain for addiction. No doctor, myself included, can claim absolute expertise in determining who is telling the truth and who is malingering. We listen very carefully to the patient's complaints and concerns, and then use our knowledge and honed intuition to try to make the best judgements.

Prior to starting MDPrevent in Florida, I had read many articles about so called "pill mills." These are medical practices run by unscrupulous doctors who feed the painkiller market's need for easy access. Wary of being bombarded by painkiller seeking patients and concerned about not making proper differentiation between those truly in need and those looking to feed an addiction or resell the pills, I decided to enlist help.

Among the many other benefits of having a health psychologist on my team, this is one of them. When I am unsure if a patient is consulting with me only for drugs, I often ask him or her if they would be willing to see the psychologist. I find this appropriate because pain usually, but not always, has a strong emotional and mental health component tied to it. I also want the patient evaluated to see if there are healthy alternatives to pills. MDPrevent's psychologist, Dr. Jessica Kordansky (PhD, trained at Emory University) specializes in Mindfulness Meditation, a natural way to deal with stress, anxiety, pain, etc.

The key concept here is at the root of how I practice medicine. I prefer to find long-term solutions over quick fixes when appropriate. Writing a painkiller prescription requires no effort and often appeases the patient, but may not necessarily be the best thing for him or her. I know this will anger some of the patients who turn to MDPrevent for care; I also know that it will decrease the number of patients who return to the practice.

Nevertheless, I must follow what I consider to be good medical practice and do what is in the best interests of my patient. This doesn't mean I will never write a prescription for pain medicine, depression, anxiety, etc.; it just means I will think long and hard before I commit a patient to this course of action, and when possible, I will solicit the help of a trained professional to improve my decision-making and offer alternatives.  Too many patients have already come to my practice on such medications having long forgotten why they were prescribed it in the first place.  It is truly an epidemic. The insanity must stop and I will do my part.

Perhaps, if other doctors did the same, the U.S. could return to fighting drug imports and not have to use precious limited resources to stop our internal painkiller problem.

1 comment:

  1. As a chronic pain sufferer, I appreciate those who are in much worse pain than I am in and are desperate for relief. Regarding over prescribed pills, have you written anything about drugging children for being "hyperactive"? Need to read studies on the practice. Does it help them? Lead to later drug use? I am a very concerned grandmother of a 5 year old boy, whom I think is headed toward that kind of recommendation by pediatriton