What is the State of Pain Management?

What is the State of Pain Management?

radnovich

Richard Radnovich, D.O.

These are dynamic times in the pain management world.

The National Institutes of Health released the National Pain Strategy, what most pain providers and patients believe is a long overdue effort. Public comment is welcome until May 20.

The backlash from the DEA’s decision to reschedule hydrocodone continues unabated. Has the DEA action had the unintended consequence of denying patients legitimate pain relief in the interest of trying to address an addiction issue?

During the course of our work at the National Pain Report, we meet a number of interesting and concerned people who think, about the issues facing the identification, treatment and education about chronic pain.

As a result, we are going to start to ask some experts about their opinions. We start with Dr. Richard Radnovich, who runs the Injury Care Medical Center in Boise, Idaho. Dr. Radnovich, who is an osteopath, is nationally known and has been involved with numerous clinical studies on pharmaceutical and medical devices that treat chronic pain. He’s involved with studies on lower back pain and on fibromyalgia currently.

He agreed to share his thoughts to some questions we had.

National Pain Report: How would you characterize the state of pain management today from the
physician’s point of view?

Dr. Radnovich:  “We are in an interesting and challenging time. We have more awareness and acceptance of pain as a disease state, we have more medications in more formulations than ever before, and most of our patients have access to a range of potentially effective medical and non-medical interventions. But was also have drug policies that suppress access to effective treatment, insurance companies that do not want to cover a range of medications or treatments, and anti-drug messages that confuse issues of pain treatment and substance abuse.”

National Pain Report: “What impact has the DEA’s emphasis on pain med usage had on the
physician and the patient?*

Dr. Radnovich: “The problem is not the DEA doing its job. The problem is that we have blurred the lines between 2 distinct problems: chronic pain treatment and substance abuse. The DEA is concerned with the latter. Medical providers just need to do a good job with the former: that is, show that they are using opioids for a legitimate medical purpose; and provide adequate medical care and supervision. I think there are some medical providers that are concerned about the DEA, and it may have caused some mistrust between the prescriber and their pain patients. That is both unfortunate and unintended. Local law enforcement and state boards of medicine can be a much bigger problem.”

National Pain Report: “On the National Pain Report, there’s been a firestorm of commentary
about basic access to pain meds–Has the government gone too far?”

Dr. Radnovich: “In most jurisdictions, hydrocodone products were the most frequently abused prescription medication. Many prescribers did not recognize that hydrocodone was such a popular drug of abuse, which perhaps led them to prescribe more freely. This was fueled, in part, by hydrocodone products’ classification as a CIII. That classification also allowed the drug to be called in. The ability to ‘phone in’ a prescription became a huge avenue for hydrocodone to be diverted for illicit use. While the change has resulted in hardship for many patients, as a policy decision, I believe it was not unreasonable.”

Editor’s Note: We had additional questions for Dr. Radnovich which we’ll publish at a later time.

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Authored by: Ed Coghlan

There are 12 comments for this article
  1. soup1657 at 11:30 am

    I hate doctors like this grow a pair my girls doc told her I’m not doing anything wrong there not going to intimidate me too bad all docs don’t stand up and say these people have it hard enough I’m not going to submit them to this without probable cause just shows how much compassion these guys have all they want is $$$$$$$$$$$

  2. David Becker at 5:47 pm

    Paita- the powers that be have not and probably will not make the effort to substantially improve pain care.It isnt just because they see people in pain as just a burden to society- its because politicians and the health care industry are morally defective- and refuse to see themselves as they are. On the contrary- they see themselves as the best thing since sliced bread-and anyone who disagrees with them, is, of course, in their narrow view of the world,wrong. And so we have a repressive society- not an open society that Karl Popper advocated or that Hannah Arendt spoke of. Our politicians can no longer deal with democracy-instead they satisfice speical interest groups that contribute to their campaigns-and ignore any individual who is not part of a special interest group. As the father of pathology knew so well- there are two causes of disease- pathological and political. THe poisonous political atmosphere in America has destroyed the hopes of too many in pain. Let us blame our politicans and health care industry and let us demand change from them. Failing that pain care will probably not get much better in our lifetimes,

  3. paita at 8:20 pm

    One more very important self evident truth of humanity is no-one can feel my physical pain,thus a decent humane respect towards others is to accept that fact,that no-one can physical feel someone else’s physical pain,thus,no-one has any right to tell anyone how much they should suffer in physical pain.!!,,In a civilized society, torture has no place,forced human suffering has no place,,,Any doctor,any D.E.A. agent ,any nurse,and ,”strategy” that allows for forced suffering of physical pain,,by deeming a physical pain an emotion,thus not allowing any painmedicine to be given because some strategy state emotion cause physical pain is forcing another human being to suffer physical pain,by forcing them to endure that physical pain w/no medicines they are committing torture or forced endurement of physical pain,,,A decent mutual human respect of thee realization that no-one can physical feel someone elses physical pain,,thus,,no-one has a humane right to force any to suffer in physical pain when they themselves has the means to stop that physical pain,,that forced endurement of physical pain should never be acceptable in a civilized society,,,,yet here comes the N.P.S.. and every where in those ,”strategy’s,”’ is forced endurement of physical pain accepted and written,,,This is why we need a law,a human right,,That no forced endurement of physical pain is ever legal or accepted in a civilized SOCIETY,,,,ie,,,,,BASIC HUMANITY 101,,

  4. Paita at 12:36 pm

    Well another long 1,,,,but first off,,,if ”unfortunate”,,or ”unintended” describes a human life,,then this Dr…should be treating spiders,,not humanbeings,,
    The biggest ,”state of physical pain management,” was perfectly exampled with this ,”Dr.s” statement, using word like unfortunate, or unintended in describing human life,,,,,THERE IS NO-MORE HUMANITY IN PHYSICAL PAIN MANAGEMNT!!!!!!!!!!!!! All these so-called experts never ever take humane treatment as their top priority when treating human beings,,,they never ever take basic human needs as a factor in any decision they force upon us,,,they never ever take basic humanity as there purpose.No-where do I see in any of what has been written anywhere,be it N.P.S.,,hhs,n.i.h,,,,no-where in any single document is it written,,,The BASIC HUMAN RIGHT TO BE FREE OF FORCED ENDUREMENT OF PHYSICAL PAIN!!!!!!!!,,,,NO-WHERE!!!! which is basic humanity in a civil society!!!!!!!!!!!!!,,which is the problem with pain management,,and it was NOT always this way,,I know this for a fact..Most of u on this site know my history,,,chronic physical pain has been my life since 1995,,thoracic,,After the typical male arrogance was over in my diagnosis, I actually got treatment,,,good treatment,,tunnel catheters,,which are syringes full of pain medicine you screw into a tube attached to your spinal column,,,accept for thee initial pain of injection,,I had no physical pain for the 1st and last time in my life,,I was functioning normally,,5’6 ish 130 perfect,normal in every way possible,,functioning 40 hours a week,,running my house hold,,perfect,,and most importantly physically pain free,,,Then some nurse who was jealous made the comment,,,well her tumors aren’t cancerous soo why does she get a tunnel catheter,,,and the down hill slide started…It did not matter the catheters worked,,it matter a policy was being violated,,,and that is exactly what is happening now a days,,,,its about policy,not stopping physical pain in another humanbeing,,,,,not humanity!!!!!!!.Not 1 single,”strategy’ in this list by this so-call ,”pro pain managenmt group,”,,,not 1 listed the basic human right to no forced endurement of physical pain,,” not 1 lists the basic human freedoms to be free of physical pain,,,not 1 states that basic humanity is first and foremost in creating any new policy,,,,not 1,,,,,So the state of pain ,management is there is no pain management for human beings in physical pain anymore,,,no-one cares about that human,,,their life,,,there lack of life,ie,basic humanity,,they care about the drug pushers,thier own employment,,but not the actual person in physical pain,,,Its about policies,personal opinions from people who have never spent 1 day in physical pain let alone 20 years,,Before the government got illegal access to our medical records was when pain management actually was real,,,they asctually cared about the physical pain being stopped,,,not about policy,,,then the government got into our private records,,and were able see how many oxycodone were being used,,and that’s all they saw,,,was a ######,,,,,,not the humanbeing behind those medicines,,but some inhumane IDIOT,, said,,,”oh look how many oxycodones are out there,wow,,toooo many,”’,,,and bingo,,our lives were turned into a forced misery,,,The fact is once the government got into our private medical issue and our medicines,,the saw our medicines as tooo many,,even though there are no statics to prove its too many,,,just a lot of ####,,and ,”they ,”feel”’ it too many,,,they did not research theses numbers,,,they did not go out and see the people behind the medicines,,,they just ,,”felt”’ it was tooo much,,and is secured jobs for every d.e.a. agent paid for by our tax dollars,,,,,it made it easy for the D.E.A. to prove their worth,,,they manipulated every piece of data to prove a lie,,,about abuse or too many,,,just like Stanford did with there ,”survey”’,,do u really think it was a coincident that this N.P.S,,,states ,”emotions control the level of physical pain,”,,,,,The bottom line is,,basic humanity is missing from pain management,,,,to fix the problem,,there needs to be a law,,stating,,,zero is the level of physical pain anyone should endure,,,thus zero tolerance to physical pain levels,,,on a scale from 1to 10,,as they always ask us,,the law needs to state 0 is the accepted level of physical pain anyone has to endure!!!!!Also basic humanity needs to guide physical pain management,,,not someone whim of ,”let try this” type thing,,,Physical pain management is very very simple,,,stop the physical pain w/medicine to the level of zero on a pain scale from 1thru 10,,,,,The government ,”policy’s has made chronic physical pain way more expensive then it has to be w/forcing psychologist on us,,forcing weird therapies on us,,forcing visits to our doctors 3 ,12 times a years,,,you do this,,or u get no relief of your pain,,ie,medicines,,,their ,”strategies make it expensive, all we want is our physical pain stopped,…,research a cure,,,but until that happened it is a god given human right to NOT be forced to endure physical pain via policies,any law,,or any arrogant s.o.b..who ,”strategy” is forcing us not to have our medicine,,,it that simple,,,the only strategy needed,,,is to stop the physical pain.WITH-OUT INFRINGEMENTS!!………that’s all we want,,,a basic human right in a civilized world,,,,,basic humanity!!!!!!!!!!!

  5. Coonhound at 3:25 am

    Hello Dr. Radnovich. I have a question. I visited your practice’s site and reviewed its content. It generally followed most other legit PM clinic’s rules and regulations. When terminating the care of patients who violate narcotic contracts it is ok to leave them w/out any avenue for a medically assisted withdrawal or a Rx to tide them over until they find a new clinic or doctor. Physicians such as yourself are smart enough to know that many disabled citizens who receive treatment at PM clinics have systemic disease processes. Abrupt discontinuation of daily use of sedatives and/or opioids also known as ‘Cold Turkey’ puts enormous stress on many systems of the human body. This can lead to seizures, heart failure, and other medical complications up to and including death.While not common for a healthy person, disabled patients are at a much greater risk of medical emergencies brought about by these policies.

    Diversion is one thing but your office states clearly in its ‘contract’ other more reasonable situations a normally compliant patient could find themselves in that could lead to dismissal.

    #1…If the medications are lost, misplaced, or stolen, REGARDLESS OF THE REASON……… I risk being discharged.
    (I misplaced a Rx one time, luckily I found it)
    #2 I WILL NOT request nor accept medications from any other physician or individual while I’m receiving medications from Dr.
    Radnovich. Besides being illegal to do so…….{First off this is NOT necessarily illegal. I have received opioids from my pulmonologist and 2 surgeons-with PM doctors knowledge and approval. This is NOT illegal. Anyone w/ a computer can google and find that this is illegal ONLY when addicts/con artists neglect to tell the physician in question of their current medications taken which are similar to the ones being prescribed-whether they requested them or they were just offered or written out. This situation is commonly referred to as doctor shopping and IS definitely illegal}.
    #13 warns of IMMEDIATE termination if any rules are broken?
    Dr.Radnovich’s full ‘contract’ can be found below:
    http://injurycaremedical.com/wp-content/uploads/2011/09/ContractForControlledSubstancePrescriptions.pdf

    Why not a taper. This avenue is provided for any other med a patient takes which causes dependency? Or at least a month of medications for the patient to use while searching for a new doctor which, if found, accepts new patients and doesnt have a months long waiting list.

    In some states, including Montana (think Dr Ibsen and his patient ‘Vicky’), doctors who terminate a patient from their practice need to provide care for 30 days after announcing decision to the patient. I would imagine that scenarios such as abrupt discontinuation, were taken into account when these rules were implemented.

    Also, do you retest urine screens which indicate possible non-compliance?

  6. Emily Ullrich at 3:01 pm

    It is a relief to see a doctor admit the tip of the iceberg of pain medicine. Thank you, Dr. Radnovich, (however trepidatiously and superficially it was touched upon) for bringing to light the issues of the blurring of pain treatment and substance abuse and the breakdown of trust that has occurred in the doctor patient relationship, due to these “crackdowns” on pain medication. These things (and a few other key important and pressing issues) are a virtual hurricane of pain treatment disaster, which are breaking down the treatment of pain patients, and leaving the country’s most vulnerable in its wake. I hope that the country starts to wake up, because people are dying every day, and losing quality of life by the thousands, maybe even millions.

  7. David at 10:26 am

    “effective” is a loaded term, Dr. Radnovich-who decides what effective pain treatment is? If someone has a 8 nrs pain from knee osteoarthritis and is given fentanyl and the fentanyl lowers the nrs to 7- is that effective treatment? Lets use another example- someone with migraine is given botulinism and PROMIS- the botulinism leads to improvement on PROMIS- but the person complains of a facial twitch and still complains of missing too many days of work due to migraine- is that effective pain treatment.
    I think, it is only too clear-that professionals have decided what “effective” pain treatment is without regard to what people in pain want. Even PROMIS-as it has no salience assessment attached to it- is still medicocentric and not person centered- need i mention PROMIS leaves out the spiritual dimension, as well?
    This article is mostly about drugs-about a clearly biomedical approach to pain- and research shows the biomedical approach to pain renders a sense of helplessness for people in pain. And so it is clear the health care industry continues to dictate to the rest of America what is effective- without genuine regard to what people in pain want or what the larger society wants.
    We are not all cultural dopes. While doctos may view the opinions of people in pain as a vernacular performance- doctors would be better off not throwing stones-and whether it is their biomedical model or a biopsychosocial model- it is is to show how little “effective” mastery of both models their is in the healthcare industry.

  8. Diane Succio at 10:22 am

    Excuse me did I hear him right. The policy causes hardship to the people who need the medication, but that’s ok.
    The DEA should be going after the pull mill Dr. Not punishing the people who really need these drugs. If they are so concerned why is it that I can walk into any pharmacy and get a box of needles without a prescription( my Husband) is a diabetic but Walmart does not know that. He could be shooting up dope for all they care.
    I am a chronic pain patient. I just had my 5th back surgery yesterday. When I do drop off my LEGAL prescription I am looked down upon, I go to 1 Dr and only use 1 pharmacy but again I am judged and questioned by some snot nose text, REALLY my Dr went to college did all his internships and happens to specialize in pain management. I have to give urine samples on demand, random pull counts but still not good enough for the DEA. It is time Dr’s stand up grow some balls and face the DEA. If they are legitimate Dr’s what is the point. Why are they punishing the real pain patients and trampling over our respect. I know how and when to take my meds, I do not sell them but am still looked down upon by some Tech wanna be Dr.

  9. joe at 10:13 am

    see I have been in a program for 13 years I have had nerve blocks and all sorts of medications now the meds I am on now just don’t work I need both shoulders replaced neck fusion has calcified and arthritis has set in I am miserable this was all workers comp and cant afford an atty to fight them self insured was a lineman for a phone company last time I was in court my pain dr and 2 others were on my side about replacement shoulders and mmj and they weren’t mmj doctors they just new the opiates don’t work anymore I am disabled and at this point believe there is no help for me and living on 1200.00 a month there isn’t going to b I am at the end of the rope tired of the pain

  10. joe at 9:49 am

    why do pain doctors not see mmj is a drug that can b used to help with chronic pain and use it for the patience

  11. NOTSONUTSO at 9:29 am

    I have been prescribed percocet for 15 yrs. I have never taken percocet for anything other than pain associated with severe peripheral neuropathy. There have been a few very disturbing instances where I was treated like a drug seeker. One doctor would only give me my pain meds if I agreed to go to AA or N/A. I have never smoked or drank alcohol in my life nor have I ever abused drugs of any kind. It was humiliating to be treated like a drug addict. I live in fear of my very kind, caring PCP retiring. I pray that my next physician will care about pain patients’ quality of life. Being without pain relief is a fate worse than death.