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Spring 2016 • Kentucky
tion and titration to effect fails to address
the underlying etiology of pain while marginalizing the motivation for change and
rehabilitation. Once a patient bypasses the
acute phase of opiate exposure, the physical dependency creates an impression that
the pain is worse without opiates when in
fact, the pain of withdrawl exaggerates the
underlying cause of pain. After the pharmacologic duration of action, opiates have
a rebound effect and thus magnify the
pain experience when the medication has
worn off. Once re-medicated, relief from
the rebound pain gives the perception that
only opiates can stave off pain. Patients
remain in a vicious cycle with the notion
that anything less than unrestricted opiate
escalation is cruel.
Insurers
Payor models often have unintended
consequences. In pain management,
there are numerous examples that hinder effective care and promote strategies without proof of efficacy. Insurance
reimbursement has long focused on
compliance monitoring, radiologic diagnoses (often superseding skilled physical
exam findings), urine toxicology, and
invasive options including surgery and
joint replacement. Low health literacy
obstacles regarding pain often require
more time with patients, a service that
is not proportionately reimbursed. It is
far easier and more lucrative to operate
or write a script than to dissect the problem and educate the patient. As a result
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patients may opt for options that are less
effective and more costly to healthcare.
Services often lacking in the repertoire
of payers involve psychological, lifestyle
counselling, rehabilitation, or regenerative
options, all tools which have very strong
track records of cost-efficacy.
Pharmaceuticals
In the short span of 20 years, opiates
have become the most prescribed medication in the country, a boon to many
pharmaceutical companies. Similar to
strategies used by the tobacco industry,
the risks and benefits of opiates were
misrepresented. As a field, we trusted
without verifying and many extrapolated
claims trumped solid science in pain
“Solutions start with accountability and it involves challenging
long-believed myths about pain management.”
– Dr. Mazloomdoost
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