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Pain in the News
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Dr. John Dombrowski provided input into a CNN story about how at the start of the Dr. Conrad Murray trial, patients are questioning the use of propofol in their care. The story does a good job of providing an overview of the appropriate use of propofol and that it is not indicated for how Michael Jackson was said to be using it.
Dr. Dombrowski’s quotes included:
And since the singer’s death, doctors have had many conversations that begin with patients saying, “I don’t want that stuff. That’s the stuff that killed Michael Jackson,” says Dr. John Dombrowski, a member of the board of directors of the American Society of Anesthesiology.
But it’s also provided a teaching opportunity for physicians to explain to patients that medications like propofol do not directly kill or harm patients; it’s the improper administration and inattention to detail that can be lethal.
“But if done safely, with the right training, it’s been [the case] for millions of patients that they go to sleep and they wake up very comfortable and safe,” Dombrowski said.
The complete article is at: http://thechart.blogs.cnn.com/2011/09/27/some-patients-question-propofol-doctor-says/
Beyond Opioids: Pain Management Specialists Offer Many Alternatives
By John F. Dombrowski, M.D., pain medicine specialist at the Washington Pain Center
Nobody plans to become dependent on or addicted to opioids. Unfortunately, it can happen to anyone while simply trying to manage severe or chronic pain. And despite their reliance on opioids, most still have pain. They – and their physicians – need better solutions.
When people have ongoing or unmanageable pain, or develop a dependence or addiction to opioids, it’s time to seek help from pain medicine specialists who can create an individualized treatment plan that draws from the many alternatives to opioids that are not only safer, but in many cases more effective.
As a physician anesthesiologist and pain medicine specialist, my goal is to help people get their lives back, instead of living pill to pill. I focus on treating people, not X-rays, and find the best approach usually involves a combination of pain management methods.
Consider Beth Hunt’s experience. A 37-year-old mother of two, Beth suffered a crushed leg in an accident and she spent three months in the hospital taking opioids to help manage the excruciating pain while recovering from multiple surgeries. Beth never dreamed she would become dependent on opioids but when she realized she was regularly anticipating her next dose, she sought the help of my ASA colleague Greg L. Thompson, M.D., president of LifeLinc Corporation (which provides anesthesia services). He devised a combination treatment plan that included using ultrasound and tiny catheters (tubes) to direct medication to the major nerves in her leg that were the source of her pain. This therapy reduced her opioid use by 90 percent while her leg healed and she learned to walk again. She no longer uses opioids and has regained her quality of life.
Beth’s experience shows that opioids can help address general pain for a limited time – such as after surgery – but are not a good long-term solution. Aside from the risk of dependence and addiction, they have plenty of unpleasant and even dangerous side effects, ranging from severe constipation and depression to shallow breathing and slowed heart rate, which can be signs of an overdose. In older people, opioids can increase the risk of falling. And they can make other medications less effective, or cause side effects. Further, there are better ways of addressing specific pain such as a pinched nerve or slipped disc, including nerve blocks and stimulation therapy.
Studies show the longer people take opioids, the more likely they are to become dependent or addicted. In an attempt to stem the tide of opioid addiction, legislators in some states have enacted prescribing limits on opioids. ASA supports patient-centered prescribing policies that consider individual patient needs, drawing on guidelines developed by medical specialty organizations. And in many areas throughout the country, prescription monitoring programs alert physicians when a patient might be “doctor shopping,” meaning going from provider to provider asking for opioid prescriptions.
Pain medicine specialists can help people in pain reduce or eliminate their reliance on opioids using a variety of treatments. For example, there are a number of high-tech methods to relieve pain such as radio wave therapy (inserting a tiny needle into nerve tissue to short-circuit pain signals) and spinal cord stimulation (in which a pacemaker-like device is implanted in the lower back and sends signals that replace the pain with a more tolerable sensation, such as tingling). Nerve blocks and pain pumps can deliver pain control where it’s needed. Some people benefit from non-drug therapies such as physical therapy, acupuncture, biofeedback, meditation or massage. And medications such as antidepressants and anti-seizure drugs can help without the risk of dependence or addiction.