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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