May 24, 2012 --More than 200 doctors, nurses and others in the health care industry gathered in downtown Portland last week to learn more about how to help patients manage pain without solely relying on prescription medication, as well as what to do when medication stops working.
The conference came on the heels of media reports that opiate painkillers have caused more overdose deaths in recent years than heroin and cocaine combined. The number of prescriptions for these pain medication has skyrocketed in recent years. Dr. Dan Roth, the Family Care provider who said he and Christine Evans, Ph.D started planning the seminar months ago.
"It is, indeed, very timely," Roth said. "I guess it is somewhat a reaction to the pendulum correcting itself." When Roth first started practicing medicine 20 years ago, painkiller prescriptions were difficult to
write. "They would put the fear of God into you about prescribing narcotics," Roth said. He recalls receiving pushback during his residency about prescribing narcotics to a patient with bone cancer from
administrators who feared the patient might become addicted to the drug -- even though her case was terminal and she was in a great deal of pain.
So many patients were being undertreated for their pain that it led to public outcry. Health care organizations relaxed their prescription policies and providers began to write more prescriptions for
narcotic painkillers. Evans' presentation focused on treating patients as if their pain is real and teaching them techniques to manage it when painkillers don't seem to be working and they ask for stronger prescriptions. Ryan Chaput, PharmD, talked about adjusting patients' prescriptions if they report their prescriptions aren't working.
"It's not just about what the prescription is doing to your patient's body," Evans said. "It's about what happens outside the patient's body, out in the community." Evans was referring to the fact that over-prescribing narcotics can lead to patients selling them to recreational users -- which can increase the number of overdoses.
Evans talked about ways to interview patients about the amount of pain they have, and also stressed empathetic listening and talking to patients about ways to cope with pain in addition to drugs -- including deep breathing and therapy to deal with the emotional issues that pain causes.
Body language, abruptness and other cues that the provider isn't taking the patient's story seriously can affect the outcome of an appointment -- even becoming a self-fulfilling prophecy, Evans said: "If you think you're not going to get anywhere with the patient, you're not going to get anywhere with the patient.
The seminar could be used as continuing medical education credit for doctors, but other health care workers were invited to attend. All of Family Care's clinics were closed so all staff could attend the
seminar, which was presented twice that day.
Image for this story by Flickr user Peacock Parables under CC BY-NC-SA 2.0 license.
