Narcotics not the only form of pain management

Published 11:00am Thursday, June 5, 2014

When the term “pain management” is mentioned in connection with an injury or problems with long-term, chronic pain, people associate it with a doctor prescribing some type of high dose or potent narcotic to get people through the day.

“We are not just going to prescribe narcotics,” said pain management specialist Dr. Scott Reed.

“Narcotics are not the main part of my practice,” he told the Vicksburg Kiwanis Club Tuesday. “A lot of people expect, or they think, that pain management is about prescribing narcotics to patients on a chronic basis.”

Using back pain treatments as an example, Reed outlined the different types of treatments available besides narcotics to help patients with chronic pain get relief.

“We look at pain from two different aspects,” he said, adding there are two types, acute pain and chronic pain.

Acute pain, he said, is something that happens from a tissue injury like a cut, or trauma, like a broken bone.

“Sometimes its accidental, and sometimes it’s purposeful, such as surgery,” he said. “Then you have more severe-type injuries, such as a massive trauma from a motor vehicle accident, or from a major surgery. At that point, you become a patient in a hospital, and that pain is also treated with an anti-inflammatory or a narcotics, a low potency narcotic or something more potent like morphine.”

With an acute injury, Reed said, the physician treating the patient will administer the medication and manage it, “because there is an expected time for the injury to heal and an expected time when that pain will dissolve.”

Chronic pain is a longer lasting pain.

“There are three definitions for chronic pain,” he said. “The first is a pain that lasts longer than three months that requires treatment; then, pain that lasts for more than six months and requires treatment; or pain that lasts longer then the normal or expected time for healing.”

The majority of the pain problems he sees, Reed said, involve pain in legs and arms, and necks and backs, adding neck and back pain account for 70 percent of the cases. “Sometimes, we see chronic abdominal or pelvic pain,” he said.

When a chronic pain patient comes to a pain management specialist, he said, “we do a thorough history and physical and take all the necessary information.”

“What we try to do is develop a treatment plan and discover the reason for the pain continuing,” Reed said. “The investigation encompasses the history of the problem. We get X-rays, MRIs and CT scans. Most of what we use are pictures, so X-rays, MRIs and CT scans. I like the MRIs better, and most pain management physicians will look at MRIS because we can see the soft tissue structures as well as the bone. X-ray-CT bone.”

Once the medical history and the tests are compiled, he said, a plan to manage the pain is developed adding that sometimes the treatment plan may not resolve the problem, requiring further investigation and a referral to another specialist such as an orthopedist or spinal surgeon, or a psychiatrist or psychologist.

“What I do is collaborate with a team,” he said, pointing out that he works with the primary care physician, other specialists, physical therapists, psychologists, psychiatrists, social workers to find a solution to a person’s pain problem. The primary physician may begin the care with physical therapy or medication.

“All of that team is a very important part, and they will all be utilized in a days work, so if I see 20 or 30 patients in a day, patients are going to be directed to those physicians or those health care workers.”

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