3 Day scripts a good idea?
With Governor Hogan’s Heroin and Opioid Prevention, Treatment and Enforcement Initiative being announced in early 2017 there has been a lot of talk recently about the appropriate number of days a narcotic prescription should been written for.
An informative and timely article, dated January 28 2017, written in the Frederick News Post by Frederick physician Dr. Julio Menocal, addressed many of the issues relating to narcotics and opioids prescribing he suggested that a 3 day rule be instituted. One of our Frederick and Leesburg based pain doctors Dr. Chirag Sanghvi and our senior staff have pondered this suggestion.
The opioid epidemic is a very real concern. As the Surgeon General pointed out in his letter to physicians dated August 25 2016, “Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”
However, expecting your internal medicine/ primary care physician to have the tools to manage genuine long-term chronic pain is unreasonable considering the huge variety of ailments they skillfully treat and juggle daily.
What are the unintended consequences of the 3 day narcotic/ opioid script?
There are many complexities involved in treating pain responsibly. The proposed three-day rule certainly addresses the need for increased monitoring of opioid and narcotic prescriptions.
However, will this rule itself achieve the desired outcome?
With the assumption that terminally ill patients, such as patients with cancer, would not be subjected to the three-day restrictions we must also look at the unintended consequences this rule may trigger:
- Large burdens on waiting rooms and provider schedules as patients fill the books with prescription refill, UDS screen and pill count appointments,
- Additional monthly cost for patients who pay co-pays for every visit,
- Increase in overall health care costs (which may be passed on to all patients eventually),
- Emotional stress on genuine patients who feel they are being treated like drug seekers.
For those who are drug seeking there are other potential consequences to keep an eye out for:
- Potential for increased incidences of “doctor shopping” in neighboring states
- Potential increased theft of medications and break-ins,
- Increase in use of heroin and alternative drugs as opioids become more difficult to obtain.
The three-day rule is certainly a conversation to be had, but perhaps equally as relevant is exploring alternative pain treatments.
Are we taking the right approach?
Many people do not realize that pain management is a specialty itself and is offered as a separate board-certification.
Unfortunately, most people seek specialist pain management care after having suffered with chronic pain for a long time and seeing physicians whose therapies are limited to pain medications.
Chronic pain along with prolonged use of narcotics causes multiple changes in the body such as changes in normal levels of circulating hormones and sleep cycles. These chronic physiologic changes can cause mood changes along with changes to how our bodies perceive pain.
The good news is that there are many alternative pain treatments available. In most cases successful pain management utilizes an integrated approach that encompasses a combination of treatments.
As physicians we recognize that the opioid epidemic is a very real and serious situation. As board-certified interventional pain specialists we also recognize there is a need to treat genuine pain responsibly.
We therefore recommend;
- Using non-surgical, interventional procedures to immediately and effectively reduce pain levels.
- In cases where medication management is necessary; reduce reliance on pharmacologic substances, maintain low doses and do not limit “pain medicine” to strong opioids & narcotics,
- Outline a detailed and carefully designed treatment plan that takes a multi-modal approach to include: weight-loss, chiropractic, physical therapy and/or counselling.
Interventional pain management procedures often enable patients to participate in and get the most out of other alternative treatments such as exercise, physical therapy or chiropractic manipulation.
These therapeutic interventions (procedures) work extremely well at the onset of pain when other physiologic changes have not yet occurred in the body and there is less damage to reverse.
Therefore, the earlier a patient seeks specialist care for their pain the less likely that patient is to be placed on a long-term medication schedule.
Barbara presented to our Frederick office with post-laminectomy syndrome (aka failed back surgery syndrome) causing lower back pain that radiated down her legs.
Read Barbara’s Q&A.
What was the nature/cause of your pain?:
I had lower back and leg pain due to complications from back surgery.
How did your condition affect your life?:
I couldn’t sit or stand up for more than 10 minutes. I experienced throbbing pain while standing up. I was forced to retire from teaching as I was unable to stand the 6 hours a day I had to. I couldn’t sleep more than 4 hours as the pain was waking me up. I had no sexual desire, no social life due to pain, and buttock pain also.
How did treatment improve your life?:
Spinal injections, along with the pain medication gave me relief.
How would you describe your experience with Newbridge Spine & Pain Center?:
All front office assistants, office manager, nurses, Drs. and Carlton McClellan are my God-saviors with their marvelous support, understanding, attention, and patience that I don’t see at other places.
What advice would you give someone else with your condition or symptoms?:
Be honest and speak up. Firmly explain your frustration with pain and be sure to give a weekly summary of what you have been doing and how you try to work through the pain in order for the doctors to understand you better.
Don’t wait too long to take your medication if pain is intolerant. Of course, follow the pain dosages as prescribed.
If you experience similar pain due to complications after back surgery we can help contact us to arrange an appointment with one of our experienced physicians in your local area.
If we’ve helped you please share your success story.
Pain Specialist Harris Shaikh, M.D.
Now seeing patients in Frederick, Maryland
Frederick, Maryland – September 29, 2014 – Newbridge Spine & Pain Center, a leading Maryland medical pain management practice dedicated to the treatment of chronic pain, has recently added two new physicians to its team of pain management providers in Frederick MD.
Harris Shaikh, MD joins the pain management team at Newbridge Spine & Pain Center in Frederick after completing his fellowship in Pain Management from The Manhattan Center for Pain Management at Mount Sinai St Luke’s-Roosevelt in New York. Dr. Shaikh, like most of the physicians at Newbridge Spine & Pain Center, has multiple board certifications including Anesthesiology and Internal Medicine.
Sana Shaikh, M.D.
Joining him in the move to Frederick is his spouse Dr. Sana Shaikh, also a board certified Anesthesiologist fellowship trained in pain management. Sana Shaikh, M.D. practiced pain management in New York prior to moving to Frederick to join the team at Newbridge Spine & Pain Center.
Harris Shaikh, M.D.
When asked what prompted them to make the move from New York to Frederick the Shaikh’s stated that the move to Frederick was a clear choice, “it was important for us to find a community that is family oriented and has values similar to ours we’re confident we’ve found that here in Frederick” said Dr. Harris Shaikh.
Regarding the choice to join the Newbridge practice he sates,
“I chose Newbridge Spine & Pain because they have a pain management philosophy which is consistent with mine; namely, using a multimodal, multidisciplinary approach that helps chronic pain patients return to the activities they love most.”
While Newbridge Spine & Pain Center brand has been in business for over five years and is conveniently located on Thomas Johnson Drive the physicians of Newbridge Spine & Pain Center, in particular founder and medical director Dr. Jay Gonchigar, have a long history of treating chronic pain in Frederick County and the surrounding area going back to 1997. With a team of fellowship trained pain management specialists Newbridge Spine & Pain is one of the few pain practices equipped with the expertise and resources to provide patients with sedation during pain management procedures, an offer that is especially welcomed by patients experiencing severe pain and anxiety.
Majid Ghauri, M.D., one of Newbridge Spine & Pain’s lead physicians, is enthusiastic about the additional pain providers, “Dr. Shaikh is a wonderful addition to our team his emphasis on and experience in multidisciplinary care is consistent with the Newbridge philosophy and his passion for chronic pain patients is a true asset to us. Additionally, we have the benefit of Dr. Sana Shaikh’s experience as a pain provider and anesthesiologist. Frederick is lucky to have them both.”
Chronic pain is one of America’s largest health challenges and can have a devastating impact on a person’s ability to do every-day-things. This fact makes Dr. Shaikh’s goal all the more promising as he hits-the-ground-running taking the Frederick practice under his wing,
“my goal is not only to help reduce pain but to help optimize our patient’s ability to perform their daily activities, pursue their hobbies and basically live a happy, active lifestyle.”
Newbridge Spine & Pain offices are located in Waldorf, Prince Frederick and Frederick, MD and now in Leesburg VA.
About Newbridge Spine & Pain Center
Newbridge Spine & Pain Center has helped thousands of patients experience effective, long-lasting relief from acute and chronic pain. By incorporating powerful, sophisticated pain-relieving treatments into customized plans of care, our pain management experts provide patients with the ability to return to living an active and healthy lifestyle. Some of the many conditions we successfully treat include back and neck pain, spinal cord disorders, cancer pain, auto & work injuries, fibromyalgia, arthritic pain and many other painful conditions.
Phantom pain is an elusive concept to some, however, this condition is very real and affects between 50%-80% of all amputees regardless of age or gender. Phantom pain is a neuropathic pain condition where the nervous system is malfunctioning and triggering real pain sensations in patients with amputated limbs.
When does phantom limb pain occur?
Image Courtesy of ashlandhumanbio.blogspot.com
Studies have shown that patients who had pain in the limb prior to amputation have a higher likelihood of experiencing phantom limb pain following amputation. Usually phantom pain occurs within an few days of amputation, however, in some cases phantom pain can develop months or even years later.
What does phantom pain feel like?
Cases of reported phantom pain have described excruciating sensations including, hands or feet being crushed, toes or fingers being stretched, bones feeling as though they have been shattered and hot pokers being thrust through the foot or hand.
What can be done to treat phantom pains?
There are a variety of treatments available for this pain condition including non-surgical interventional procedures and alternative treatments. The appropraite course of treatment is always dependant on the individual patient.
Non-Surgical Pain Procedures:
- TENS units
- Physical Therapy
At Newbridge Spine & Pain Center our initial consultation always includes an assessment of your current treatments as well as your condition. We treat the person and their pain and employ a multi-disciplinary approach to managing pain that is highly personalized.