SCE Arizona: Pain patients must focus on quality of life

It’s commonplace for physicians to ask patients to rate their level of pain. Mel Pohl, MD, DFASAM, chief medical officer at the Las Vegas Recovery Center, told attendees at the Summit for Clinical Excellence event on Thursday it’s time for a new question: How is your life?

“We should pay attention to quality of life,” Pohl said during his keynote. “General anesthesia offers a pain-free state, but that’s no way to live life.”

Pohl guided attendees through the differences in treating acute pain and chronic pain, offering recommendations on the use of opioids, as well as alternatives of both pharmacological and non-medication varieties.

Five key factors are driving the opioid epidemic:

• All pain is real. Different clients have different thresholds for pain, and they feel pain in different ways. Not being able to identify specific tissue damage doesn’t necessarily mean patients aren’t actually hurting.
• Emotions drive the experience of chronic pain. “Here is where we miss the boat,” Pohl said. “If we don’t pay attention and clients don’t tend to their emotions, they will never get better.”
• Opioids often make pain worse, Pohl said, noting that some patients taking opioids reach a dangerous level of dependence.
• Treating to improve function is critical. When patients’ focus is shifted toward their level of function instead of their level of pain, they regularly self-report lower pain scores as their ability to function improves, he said.
• Expectations influence outcomes. A client’s mindset is impactful on their outcome, so clinicians need to set proper expectations at the outset of pain treatment. Three reasonable goals of pain management should be to first maintain function, then improve function and eventually reduce discomfort by about 50%.

Practitioners who do use opioids in pain management should prescribe at the lowest dose for the shortest length possible, as long-term opioid use often begins with the treatment of acute pain, Pohl said. A small amount of opioids, prescribed over a period of three to seven days, can serve as a “rescue dose,” as three days’ worth of opioid medication often is sufficient to treat acute pain. Rarely is more than seven days’ worth needed, he said. Pohl added that ongoing assessments of the effectiveness of the medication are needed, and prescribers should not enter into the use of opioids in treatment without an exit strategy in mind.

Tricyclic antidepressants, selective serotonin and norepinepherine reuptake inhibitors, anti-convulsants, some muscle relaxants, and topical treatments can serve as effective alternative medications to opioids. Pohl also advocated for the use of physical therapy, chiropractic treatments, therapeutic massage, acupuncture, good nutrition and hydration and mindfulness-based stress reduction.

“The most important thing we can impart is that movement will provide relief, and being inactive causes more pain,” Pohl said.