By Summer Davis
Pain management in the era of an opioid addiction epidemic — arguably one of the worst drug crisis in U.S. history — calls for physicians to first draw on a variety of other drugs and treatments, said one of the region’s leading experts.
Dr. Rakesh Patel, a physician at Henry Community Health in New Castle, Indiana, specializes in pain management, physical medicine and rehabilitation. His patients come to him to manage ailments like chronic lower back pain when other treatments like physical therapy, anti-inflammatories, muscle relaxers and sometimes even acupuncture, haven’t worked. When patients visit Patel, they typically already have been prescribed chronic opioid treatment, and it is up to him how to proceed with this treatment and adjust it to control the patient’s pain as best as possible.
In 2017, the number of overdose deaths involving opioids — including prescription opioids and illegal opioids like heroin — was six times higher than in 1999.
“More high risk patients, who maybe have a family history of addiction or have abused drugs before, we more closely monitor,” said Patel. “We do this by urine drug screenings and prescribing them a lower quantity of opioids. Even if my patient is addicted, they still need pain management.”
Patel said typically treats his patients with short-acting Hydrocodone. He also prescribes short-acting Oxycodone and Percocet, as needed, but steers clear of long-acting opioids because of the higher risk for overdose.
“We now have the option of doing genetic testing,” Patel said. “This determines their genetic profile (and) which medication works best for them.”
For patients addicted to opioids, Patel recommends help from an addiction specialist and a prescription of Suboxone or Methadone, which are drugs used to manage opioid dependence. Patel says education is key. Community drug addiction centers are another alternative, though the area offers few options for in-patient or residential rehabilitation.
“In my opinion, detox with an addiction specialist is not enough for a patient who is addicted to multiple substances,” Patel said.
Kristi Dunigan, the political community liaison for Bridges of Hope Treatment Center in Anderson, Indiana, says residential treatment is a key to long-term success.
“Addicts need stability more than anything, and I believe we not only treat the body, but also the mind and soul,” Dunigan said.
Patel says it also is helpful for patients to share their experiences with others. “For other pain management solutions to really stick, like meditation, yoga, massage, it helps if they see these methods be effective for other people, so peer groups, counseling with people with similar conditions could be a good solution.”