Try interventional pain management to avoid opioids
Don’ t succumb to the pain
Try interventional pain management to avoid opioids
n BY MITCHELL KRUGEL
Pain: That stabbing in the lower back from getting knocked on your butt when responding to the domestic a few months earlier. Or the pins and needles running down the leg into the foot that has radiated from all those years of sitting in the patrol car. And the strain that comes every morning when putting on the vest and the duty belt.
Dr. Marcello Sammarone feels your pain. In the Parsippany office of his Advanced Pain Therapy practice, Dr. Sammarone sees patients every day with all types and levels of pain, running the gamut of the lives of first responders. He recommends a series of options to deal with the pain, including physical therapy, anti-inflammatory meds, epidural or nerve block injections and other aspects of his innovative interventional pain management approach.
More importantly, he knows what not to do. And that’ s prescribing a narcotic opioid to mask the pain, risking addiction and perhaps your job.
“ When managing pain, narcotics are like putting a Band-Aid on an open wound,” asserts Dr. Sammarone, a board-certified pain management physician who has been practicing for more than 25 years.“ An open wound will not heal with a Band-Aid. You need to go to the source of the pain. That’ s the message here: Law enforcement officers should know that there are pain treatments available that are not narcotics.”
As law enforcement officers have seen up close, the opioid epidemic has become an evil empire.
Every day, more than 115 Americans die from an opioid overdose. The misuse of and addiction to opioids— including prescription pain relievers, heroin and synthetic opioids such as fentanyl— is a serious national crisis that affects public health, as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the U. S. is $ 78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.
The wake of the opioid crisis also includes:
• Roughly 21 to 29 percent of patients who take prescribed opioids for chronic pain misuse them.
• Between 8 and 12 percent develop an opioid use disorder.
• Opioid overdoses increased 30 percent from July 2016 to September 2017 in 52 areas in 45 states.
“ Treating chronic pain long-term with opioids is of course a slippery slope,” Dr. Sammarone warns.“ Officers also risk their jobs by taking opioids and getting caught in a random drug screen. There’ s no magic bullet, but if you have that kind of pain, you need to see a doctor who specializes in interventional pain medicine and whose interest is not to operate, but to treat patients using noninvasive procedures.”
Because of the predisposition to addiction that can lead to overdose, Dr. Sammarone wants to share some of his learning events about prescribing the use of opioid narcotics as painkillers. He notes that doctors must have a license to prescribe Vicodin and other such opioids, and it must be authorized by
the DEA.
He points out the distinction between a muscle relaxant and an opioid by explaining that a muscle relaxant can be helpful to ease the pain keeping you awake at night. And he is very direct about what happens when you go to the dark side of opioids.
“ Opioids cause withdrawal symptoms, so if you don’ t take it, your body goes into withdrawal with symptoms of nausea, vomiting, a high level of anxiety and diarrhea,” Dr. Sammarone describes.“ Therefore, you seek to take more medication to prevent symptoms. And if you take them for a few weeks, your body gets immune to them, so you need more to achieve the same level of pain relief. And that’ s how they become habit-forming.”
He worries that in some professions, like law enforcement, people have addictive personalities. Those who like to smoke or drink or have a family history are at greater risk of becoming addicted to opioids. Bipolar disorder, attention deficit disorder( ADD) and other psychiatric disorders can also feed opioid addiction.
Before he ever prescribes a narcotic painkiller for shortterm use, Dr. Sammarone’ s staff completes a thorough internet search as part of New Jersey’ s monitoring program to see if a patient has trouble in his or her background that could lead to addiction. And when he does prescribe them, he asks patients to sign an opioid use agreement that limits use to a two- or three-week course.
The alternatives to opioids, Dr. Sammarone suggests, can begin with using an anti-inflammatory medication such as Motrin and physical therapy that includes stretching and core-strengthening exercises. Also, he says never to rule out rest as a means to reduce pain.
If the pain continues for more than four weeks, then it’ s probably time to consult an interventional pain management specialist like Dr. Sammarone. His non-opioid treatment options include epidural, facet and trigger point injections to hit nerves around the discs or other injured areas with small amounts of anesthetic or steroids. Initially, he is trying to identify the areas where the pain is emanating from.
“ If we can confirm the pain is coming from those joints and provide some relief with a diagnostic injection, then we can move to more targeted forms of treatment,” Dr. Sammarone explains.“ These are more so-called permanent approaches, like radio frequency“ heat” treatment, for which we see a 70- to 80-percent success rate. If the pain returns, the procedure can be repeated.”
There are cases that don’ t respond to interventional pain management, but Dr. Sammarone advises that law enforcement officers should not be too quick to opt for surgery. Because of their insurance benefits, officers can get easy access to surgery.
“ But surgery is a necessary evil that should be considered when conservative treatments fail,” he adds.“ There’ s a great chance that going through the treatment progression and not resorting solely to opioids to get relief.”
The goal is to use a reasonable amount of opioids and slowly wean down, and eventually off, once the pain has subsided. d
86 NEW JERSEY COPS ■ APRIL 2018