Prescribing opioids only one aspect of pain management

September 6, 2018

EDITOR’S NOTE: This is the first installment of a 5-week series covering opioid use and treatment which will run each Thursday through Oct. 4.

BULLHEAD CITY — Pain management isn’t a new field of medicine, but with increased focus on the opioid epidemic in America, it is often a misunderstood specialty with unrealistic expectations by patients, according to one local doctor.

Dr. Paul Sutera is an anesthesiologist and pain medicine specialist who creates individualized plans for patients to help them alleviate their discomfort.

According to the physician with Silver Creek Medical Associates, long-term prescription drug reliance isn’t a good thing for most people.

Sutera emphasized that, for most patients, opioids aren’t the only pharmaceutical option and that drugs aren’t the only way to manage pain.

The latter philosophy can be hard for some patients to believe, he said.

“People want to have immediate relief,” Sutera said. “And Big Pharm companies jump on the bandwagon and say ‘here’s a pill.’ ”

A multifaceted approach, including relaxation techniques, can help patients better cope with chronic pain.

“Anxiety can increase your pain by up to 50 percent,” Sutera said.

Tai chi, yoga or some other forms of physical activity also can provide benefits to people who are dealing with physical discomfort.

During the 1990s, concerns about treating pain leaned in the opposite direction and doctors were accused of underestimating patients’ pain. But that has changed, Sutera said.

“You have to be active — and proactive — toward your own health and mental health,” he said.

Management is different from being totally free from pain and not always something that can be achieved for many patients, Sutera said.

According to the doctor with more than 20 years experience, patients often “need to mature into acceptance of a certain amount of pain.”

With the state of Arizona now focused on reducing use of opioids, there are new guidelines for care providers coming from a variety of directions.

The group of physicians targeted by new state guidelines are primary care providers, but insurers, medical boards and other agencies are pressuring all physicians in Arizona to rethink their prescribing practices, according to Kaiser Health News.

That, Sutera said, “is changing how we all do things.”

One area pharmacy agrees with the view that it’s best to prescribe medicines — including opioids — carefully.

The goal is to provide “the lowest dose for the shortest amount of time possible,” said Ashley Elms, manager of the Althea Pharmacy in Fort Mohave.

In a plastic paper protector on the pharmacy’s counter is information for patients about using prescription opioids that was written by the U.S. Centers for Disease Control and Prevention.

It suggests various non-opioid pain management options, including use of pain relievers such as acetaminophen, ibuprofen and naproxen that might work better (depending on a patient’s medical background, condition and needs) as well as cognitive behavioral therapy, in which patients learn how to modify triggers that increase pain and stress.

Increased risks of dependence and side effects could result from prolonged opioid use — even when the drugs are taken as directed by a physician, according to the pamphlet.

Among these are tolerance to the prescribed dosage that brings about the need to overuse, physical dependence, increased sensitivity to pain and a host of other mental and physical changes: constipation, nausea, vomiting, dry mouth, sleepiness, dizziness, confusion, depression, decreased testosterone levels, itching and sweating are among the most common.

“Prescription opioids carry serious risks of addiction and overdose, especially with prolonged use. And opioid overdose, often marked by slowed breathing, can cause sudden death,” it reads.

But the warnings have not prevented opioid addiction from becoming a health crisis.

“If prescription drugs are used appropriately to treat people who have chronic pain, the practice of pain management is of a great benefit,” said Ashley Tozier, Southwest Behavioral and Health Services’ director of local clinics in Bullhead City.

While local patients who rely on pain management have options to help them that don’t require use of drugs, they don’t have easy access to the same array of choices as patients living in big cities, such as Las Vegas and Phoenix.

“Advanced and alternative treatments aren’t always available,” Tozier said.

Treatment of terminally ill patients, however, is different and their options most often are much more limited than the rest of Sutera’s patients. Plans for these people haven’t been affected by Arizona’s new guidelines, Sutera added.

While there has been some talk of Sutera no longer being allowed to prescribe opioids, he said that rumor is simply untrue.

“A lot of unethical people spread rumors,” he said about the idea that he was ordered to stop providing patients with medication they might need. “I’ve never had any sanctions of any kind.”

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