At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference on June 14, Carlos Roman, MD, of the Arkansas Specialty Orthopaedic Surgery Center and Pain Care Center, discussed opioid pain management. His session, titled “New Concepts in Prescribing Opioids,” focused on the problems with opioid abuse that exist in our culture today and how to better help patient manage pain with fewer risks.
The current model for prescribing opioids was started in the 1990s and is based on titration or increasing dosage until pain is resolved. However, this approach has proved detrimental to millions of people in need of pain management who become addicted or tolerant to opioids, Dr. Roman said.
"It's easy to sell things that are addictive," he said. "Opioid withdrawal is physically and emotionally worse than nicotine, and even the non-addicted can get trapped."
Americans consume 80 percent of the world's pain killers, and opioid prescriptions are up 600 percent in the last decade. However, disability rates are also skyrocketing. "You have to look at the correlation," Dr. Roman said. "He are heading in the opposite direction [of healing]."
Increased opioid prescriptions are also driving healthcare costs. Oxycotin costs about $1,900 compared to a $290 Lidoperm patch for the same amount of medication.
Other problems with opioid overuse include interference with sleep cycles, lowered testosterone, constipation and other consequences from interferance with a complex hormonal system.
Dr. Roman encouraged pain management physicians to know and educate patients about the risk of opioids and to use the medications as temporary ways to relieve pain when a patient is hurting, rather than allowing them to be in a patient's blood stream constantly.
"Working patients down from high opioid level is incredibly gratifying," he said. "Patients wake up out of drug dependency, and that is very gratifying."
When helping a patient wean from the drugs, remind them that they are likely not to blame for the dependency any more than someone who developed a drug allergy. There is little education on how to taper a patient off narcotics; be patient and expect to hit plateaus, he said.
The current model for prescribing opioids was started in the 1990s and is based on titration or increasing dosage until pain is resolved. However, this approach has proved detrimental to millions of people in need of pain management who become addicted or tolerant to opioids, Dr. Roman said.
"It's easy to sell things that are addictive," he said. "Opioid withdrawal is physically and emotionally worse than nicotine, and even the non-addicted can get trapped."
Americans consume 80 percent of the world's pain killers, and opioid prescriptions are up 600 percent in the last decade. However, disability rates are also skyrocketing. "You have to look at the correlation," Dr. Roman said. "He are heading in the opposite direction [of healing]."
Increased opioid prescriptions are also driving healthcare costs. Oxycotin costs about $1,900 compared to a $290 Lidoperm patch for the same amount of medication.
Other problems with opioid overuse include interference with sleep cycles, lowered testosterone, constipation and other consequences from interferance with a complex hormonal system.
Dr. Roman encouraged pain management physicians to know and educate patients about the risk of opioids and to use the medications as temporary ways to relieve pain when a patient is hurting, rather than allowing them to be in a patient's blood stream constantly.
"Working patients down from high opioid level is incredibly gratifying," he said. "Patients wake up out of drug dependency, and that is very gratifying."
When helping a patient wean from the drugs, remind them that they are likely not to blame for the dependency any more than someone who developed a drug allergy. There is little education on how to taper a patient off narcotics; be patient and expect to hit plateaus, he said.