Non-Narcotic Pain Relief Options Getting Cooler

Non-Narcotic Pain Relief Options Getting Cooler

Dr. Chad Stephens of Noble Pain Management and Sports Medicine in Fort Worth, Texas says October 14, 2014 is a day that changed pain forever.  That when the federal government (specifically the DEA) posted its final rule that moved hydrocodone combination products from Schedule III to Schedule II of the Controlled Substances Act.

Stephens was talking with the National Pain Report recently about non-narcotic treatment for chronic pain.

“I’m an interventional pain physician rather than just a prescription writer,” he said. “So I’m looking for procedures that can help my patients get their lifestyles back and get them active again.”

One of those patients is 67 year old Margaret Anderson who was diagnosed with sacroiliac joint pain in 2012. She was miserable. She estimated she was taking about 18 Advil per day to try and deal with the pain, and it just didn’t help. She didn’t want to take anything stronger.

She couldn’t sleep and said it hurt the most when she laid down, and could sit but not for very long periods of times.

“I spoke with Dr. Stephens about my options and he talked about a steroid injection but said that he couldn’t guarantee how much it would help and how long it would last.”

That last part is important to patients.

“People care how long any procedure will help,” Dr Stephens said.

So he recommend the COOLIEF Cooled Radiofrequency which is a minimally invasive treatment option that takes up to 30 minutes targeting nerves that are causing pain. It is a non-invasive outpatient treatment option for those suffering from joint and back pain.

“I tell the patient that the nerve will regenerate in one to two years after the procedure,” he said. “Patients like knowing they could be relatively pain free for that period of time.”

For Margaret Anderson, who first had the procedure performed in 2012, and had a second one in 2014, it worked well. She has taken no pain medicine since first having the procedure and is back to gardening, working part-time at a local funeral home and generally” it has allowed me to do whatever I like”.

Dr. Stephens likes the procedure.

“If writing a prescription can help the patient, that’s great. However if you can give them a procedure that can both restore their lives and delay surgery and get them off the pain medications, that’s even better,” he said.

“Surgery isn’t for everyone. That’s why we focus on bringing non-surgical pain relief options within reach of those suffering from chronic pain,” he said. “It’s nice to be able to say we have a minimally invasive procedure that has no downside.”

He said there are great non-narcotic pain relief modalities becoming available but that insurance companies don’t always cover them (although COOLIEF is covered).

“Various insurance companies are not covering all the things we can do,” he said. “We are in a weird climate – we have to have multiple calls with medical directors of insurance companies. It’s frustrating that we can’t serve the patient totally.”

He worries that patients are getting what he called “a runaround” and says that we (physicians) have to convince insurance companies to cover more of these minimally invasive intervention.

Some patients will pay for uncovered procedures but obviously many people can’t afford to do that. Some people move for a surgical intervention, perhaps before they need to, according to Dr. Stephens.

He recommends, “Before you have to go to surgery, go to a pain doctor – a lot of people can find relief and not have to go the surgeon.”


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Authored by: Ed Coghlan

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To John S,
John, one of the brand names for hydrocodone was Vicodin, not Percoset. Percocet has always been schedule II but Vicodin was schedule III. Percoset is a brand name for oxycodone. I live in Virginia but my pain specialist is in California. The requirement for being seen is every 90 days and I am happy with that. Once every 30 days would be quite a hardship for me (it’s already hard enough – SMILE). Ninety days is adequate once a patient is stable. I’ve been on the same dose for 5 years and still feel comfortable. In fact, at 65 years old, I am experiencing the highest quality of life I’ve ever had as an adult. Wishing you the best!


After going thru injections for 2 years I had the radio frequency done. Bless those who it last 2 years on because it barely lasted 2 months on me. PT was so brutal and they would not listen when I would say it hurt my back and hip so bad. No relief just tears. Then came a hip injection that left me unable to walk at all and pretty much screaming daily for a year until finally a doctor replaced that. Trust me I don’t want to take Opoid’s and have tried them all but now just take one that only gives me a dulling of the pain. It;s the only thing that keeps me half way sane to be able to still live at home with the help of my son and can only walk with the aide of a walker. I am in tremendous pain daily and have spent 3 years trying alternative treatments but when the OA takes over your body and the doctors say they are pretty much at a stand still with how they can treat you, well you just keep waiting those 4 hours until your next pain dose so maybe you can get a shower or make something to eat before the pain is full blast again. Unfortunately some of us need those Opoids even though we hate taking them

It was my understanding that when Hydrocodone first came out; the drug was the laboratory produced version of Percocet. I thought it was always a schedule II drug. The worst part is that by making it a schedule III it could be refilled by doctors up to 4 or 6 times and this meant people didn’t need to go to their doctor every month for a prescription.

Is that the beginning of the problem ? Shouldn’t a patient suffering from chronic pain need to see the doctor every month when strong medication is being used for pain on a daily basis ?

Going to my pain doctor for me isn’t an issue, I want to talk to my doctor as often as I can and I need my doctor to know just exactly how I’m doing with my pain level. My dose has not changed in over 4 or 5 years but my condition is worse and my pain is worse and I don’t want to up my dose at least not right now.

No surgeon will touch me or my back unless I start to have bowel and or bladder problems. If that happens I’m running to the doctor. After eleven back operations my condition is like a ticking time bomb and so far everything they told me about it getting worse has happened and it scares the hell out of me. My pain is unbearable if not for the pain medicine I take. I see a Chiropractor and I keep in shape but the nerves are trapped and under a lot of pressure. My doctor tells me my pain is similar to cancer pain without the cancer.

Taking pain meds away from people that suffer severe pain is not the answer and it will only cause more problems as we can plainly see. They are a political hot potato and many feel the answer is to just get rid of them and use antidepressants – that’s not the answer either. There’s middle ground here and it needs to be found now.



Kurt WG Matthies

Interventional pain medicine procedures, specifically RFA neurotomy gives my arthritic facets excellent pain relief, but it has its limitations. Without adjunct opioid therapy, I’d be homebound and in misery.

That said, board certified pain docs (DABPM) are often the best consulting physician for people withpain syndromes because they’re training includes a thorough understanding of chronic pain and medical management of pain with opioid analgesics and other medications.

Yet, PCPs still refer their patients with abnormal MRIs to surgeons most of thetime.

Part of our new pain initiative needs to include education of primary care providers about appropriate use of interventional pain consults.