By Ed Coghlan.
Editor’s Note: From time to time the National Pain Report likes to engage physicians on the front line of treating chronic pain and gain their perspective on the state of chronic pain treatment. We were introduced to Dr. Amy Pearson of the University of Iowa who is establishing herself as a leader in the field. She agreed to answer a few questions:
National Pain Report: “Dr. Pearson, Let’s discuss the opioid issue – What’s your position on prescribing them?”
Dr. Pearson: “There’s no one-size-fits-all position on opioid prescribing. When a physician is considering opioid therapy for his or her patients, he or she considers all of the available evidence as it applies to the patient. Just like any other medication, opioids have good evidence for some conditions, but poor evidence for others. Physicians are always adjusting their practices as more information comes to light.
National Pain Report: “Many chronic pain patients who have used opioids for years to combat pain are upset at the perceived “crackdown”. One observation I hear from many is if not opioids, then what? No one seems to be talking about alternatives. What say you?”
Dr. Pearson: “There are a lot of options for chronic pain, but the answer to this largely depends on the condition being treated. Medications are just one of many ways to treat chronic pain, and often the best chronic pain treatment requires a multidisciplinary, active approach. A patient’s team might include a pain physician, a primary care physician, a pharmacist, a surgeon, nurse specialists, a physical therapist, or a pain psychologist. Depending on the condition, certain specialties are more heavily relied upon. For example, I may have a patient who is improving his fibromyalgia pain with regular aqua therapy and biofeedback sessions. I may have a different patient with persistent pain after spine surgery who is optimizing her home exercise program and medications in preparation for a spinal cord stimulator implant.
National Pain Report: “Pain is hard to measure–what might be a 5 for one person is a 7 for someone else. What can you recommend to patients about talking with their physician about their pain and the treatment alternatives?”
Dr. Pearson: “This is a common problem in medicine, but not insurmountable. A pain “score” is just one part of the pain evaluation, and it’s important to follow trends. Most of the time, descriptors like the quality (cramping, burning, aching, searing, dull) and location of the pain can help physicians hone in on the problem. It helps to know what has worked and what hasn’t, and whether the pain is associated with anything in particular. One of the most important trends to follow is whether treatments are helping you achieve your goals, whether that’s being able to go out with a friend, rely less on assistive devices, or sleep better.”
National Pain Report: “How can we restore an integrated approach to treating pain? Is it a system problem, is it a medical training problem. What exactly is your prescription to improve how we treat pain?”
Dr. Pearson: “Treating pain is an expensive endeavor for patients, their families, and the medical system because of the multidisciplinary care and time involved. Many patients are complex, with multiple contributing medical problems. Often times, my patients have more than one pain problem. For example, someone might have diagnoses of fibromyalgia, a disc problem, and rheumatoid arthritis. Each problem has subtle differences in how it is treated, and influences which interventions a doctor might choose. I am lucky to work where I have enough time to sit down with a patient, review their scans and treatment, and make a comprehensive treatment plan. I realize this is a luxury that is not very common in modern medicine. I think as a whole, we need to realize that pain care simply takes more time and resources to achieve meaningful results, which will pay off in the long run.”
National Pain Report: “While the pain story for 2017 was the opioid issue – what progress did you see during the year in terms of treatment, new technologies etc.?”
Dr. Pearson: “In my field, one of the most exciting developments is in the field of neuromodulation. Pain doctors have been using devices called spinal cord stimulators to improve pain, especially when pain persists after a spine surgery. There has been a wave of new literature coming out on different ways to implant and program stimulators to get better results than we ever have before. This technology might help us reach even more patients with harder-to-treat conditions. The field of pain medicine is moving more towards a focus on restoring function and quality of life, not just passively managing symptoms, and I am very excited about that.”
National Pain Report: “As a pain specialist, it must pain you – if you’ll pardon the very bad pun – that insurance still doesn’t many cover alternative treatments that are available. What must happen for broader coverage of treatments?
Dr. Pearson: “There are physicians and professional societies working many unpaid hours to advocate for patients’ access to the right care. Many hours that could be spent treating more patients must instead be spent on phone calls, advocacy, and paperwork. We need more patients and physicians at the table when it comes to shaping health policy, reimbursement, and access to care. Insurance companies and politicians need to see the personal connection. We also need more research funding for treatment of pain so we can prove the value of new interventions. We have established that pain is a problem in our country; now is the time to focus on what we can do about it.”