doctor specializing in pain management
includes the variety of
spine injections, cauterizing painful
nerves and implantable devices
for pain. Additionally, medications
for pain are taught, and expected
in the real world as these
physicians typically manage the
higher levels of pain medication
for their complex pain management
patients. For Dr’s Grove
and Kubitz both the interventional
and pharmacologic aspect was
their niche, their passion. Both
trained from institutions that
heavily espoused a comprehensive
approach to pain management
(Mayo Clinic, Harvard and
Stanford) and opioids were seen
as appropriate for severe pain
syndromes (in a safe and judicious
manner) when other less
prominent pain medications have
been tried. Prior to the 2016 Center
for Disease Control (CDC)
guidelines, opioid limits were
primarily based on clinical and
functional parameters of each and
every individual patient. A delicate
and nuanced assessment of
risk and benefit.
As ongoing issues related to opioid
deaths and hospitalizations
from 2000-2010 continued to
climb, federal regulatory agencies,
state medical societies and
state health departments started
to take notice. In the fall of 2016,
the federal government started
efforts to reduce the amount and
strength of what a pain management
patient could be prescribed.
The CDC released its first ever
guidelines for opioid prescribing
for non-cancer pain. The audience
for these guidelines were
intended to be primary care physicians.
In reality, the guidelines
were adopted by many of the
commercial insurances as a way
to mitigate the ever-increasing
amount of opioid medications for
pain that were being prescribed
(and they were subsequently paying
for).
(Connued on page 42)
Internaonal Pain Foundaon—43