Pain Management in Tennessee: A Three-Way Tug-of-War

CHATTANOOGA, Tenn. - May 11, 2013 - PRLog -- by Dr. Marc Valley, MD

Newspapers report on prescription pain medication abuse on a daily basis. We read of people, often little older than children, dying of prescription medication overdoses, arrests involving the transportation of illegally obtained prescription medications into and out of our state, and patients demanding inappropriate treatment for their pain.

These issues confront patients, physicians and the state governments of every state in the nation. Tennessee is at the forefront of this battle; a tug-of-war between patients, physicians and the government. To understand this struggle, we have to understand the parties involved.

First, there are the patients seeking care for their medical problems and conditions. Statistically, most patients with pain seek to resolve their pain without taking prescription medication. Unfortunately, not all patients are like this. A very small minority want to direct their care towards medications to help them feel better – medications like narcotics and sedatives. Additionally, there are some who have no intention of taking these medications at all, but only intend to sell them illegally.

Second, we have to understand the government’s role. Local, state, and federal authorities, coupled with the Health Department and the Boards of Pharmacy and Medicine, continue to focus on the growing problem of prescription drug abuse in Tennessee. This abuse has resulted in more emergency room visits than almost all other drugs of abuse combined, with an exploding number of deaths. Further, the criminal system supporting the “professional” diversion of these medications is growing, and is associated with its own problems. The burdens of this diversion, both financial and to the public health, are growing and becoming unsustainable. The goal of the state government is to prevent this. Unfortunately, government officials are not physicians; they often do not understand the difference between an appropriate patient and physician, and one that should be taken off the street.

The third leg of the tug-of-war are physicians who are caught in the middle. Physicians are trained to evaluate and treat patients with physical ailments, as well as the pain associated with these ailments. However, we assume that the people who we treat truly have real ailments and want to be cured. In general, physicians assume honesty from their patients, and do not want to enter into an adversarial relationship. Additionally, the physician who continues to treat pain patients must set up an extensive and expensive administrative system to assess patients for possible diversion and to obtain lab specimens to confirm that the patient is telling the truth. In my practice, this administrative burden has doubled the time per patient, cutting into how many patients I can care for.

And finally, the dark side of the problem. The criminals: “patient”, physician, and pharmacy. These people are in it for the money. Although they are but a small portion of all patients, physicians, and pharmacies, they produce all of the negative publicity and paint the real patients, physicians, and pharmacies with the same dark brush.

What are the consequences of this tug-of-war? Real patients who are suffering are losing their physicians who no longer want to take the risk of prescribing these medications. Their suffering will continue. Physicians are becoming more and more resistant to appropriately medicate their patients.

What is the answer to this growing problem? Pain management is now a specialty, just like surgery and internal medicine. Patients should go to a physician who is board certified in pain management, who is trained to identify the cause and appropriate treatment of painful conditions, preferably without the use of narcotic medications which have significant side effects. Physicians should refer their patients to such specialists in order to ensure the best care for their patients. This will allow the state government to identify the physicians who are expert in this area, and those who are not.

These changes are taking place, but the transition period will be hard. Recent legislation has focused on the appropriate qualifications to operate a pain management practice as well as to define that these medications are often appropriate, if used with care. However, the public must understand that the days of only having to deal with their family physician for all aspects of care, especially pain management, are gone forever.

Dr. Marc Valley, MD is a board certified anesthesiologist and a pain management specialist who received his training in the Air Force and at Johns Hopkins University. Dr. Valley is the founder of CIRCE Medical Services, a Chattanooga-based pain management practice. He has practiced for over 25 years in the fields of interventional and non-interventional pain management. CIRCE Medical Services can be found online at www.circetn.com.