Monday Medical: Painkillers not always the answer

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— Pain hurts. And it is supposed to. It signals the need to pay attention to an injury, illness or condition.

Several Steamboat Springs physicians are concerned that requests for narcotic painkillers are increasing along with expectations for being pain-free.

Laila Powers, M.D., has been an emergency medicine physician at Yampa Valley Medical Center for 11 years. She also is the medical director of Routt County Emergency Medical Services.

During the past couple of decades, she has seen a rising demand for narcotics to treat minor injuries, as well as chronic pain.

“Pain is the reason for many visits to YVMC’s Emergency Department,” Powers said. “We are very interested in helping with sudden or acute pain, but there is no adequate study to show that the ED is the appropriate place to treat chronic pain.

“Society has forgotten that injuries hurt and take time to heal. Pain can be a good thing — it tells you when you should back off of your activity so you don’t do more injury.

“Medication may take the edge off the pain, but we can’t take away 100 percent of the pain,” she added. “Narcotics only mask the symptom; they do not get to the source of the problem.”

Steamboat Springs family medicine physician David Niedermeier, M.D., agrees.

“The expectation of pain with injuries and surgery may not be realistic,” he said. “Injuries hurt, surgery hurts. The goal needs to be to manage pain to a reasonable, tolerable level but not to treat to a pain level of zero.”

Hospitals and physicians in the United States ask patients to describe their pain on a scale of zero to 10. Lower numbers are for mild pain, and the highest numbers are intended to describe the worst imaginable pain.

“A minor injury that is lower on the pain scale can often be treated with ice and anti-inflammatory medication,” Powers said. “These ‘old-fashioned’ remedies are more effective than narcotics.”

Powers, Niedermeier and other local doctors are concerned about a growing reliance on narcotics among adults, adolescents and even children. These powerful painkillers have significant side effects, and there is potential for misuse and addiction.

“We know that 25 percent to 30 percent of all pain meds prescribed are not taken as prescribed,” Niedermeier said. “Some solutions are to have providers prescribe lower numbers so there are fewer leftovers, patients need to safely discard unused medications and meds need to be kept in a safe place, not in the medicine cabinet.”

“Narcotics are addictive, even for short courses,” Powers said. “In the ED, we will prescribe a two-day to four-day supply with no refills. That’s our practice for patient safety.”

Brian Siegel, M.D., medical director of YVMC’s Pain Management program, said pain is a complex issue. Acute pain can evolve into chronic pain if not properly treated, but narcotics are not the answer to all pain issues.

“If narcotics or other oral pain medications are prescribed, it should be at the lowest effective dose,” he said.

Chronic pain often has an associated psychological component, such as anxiety or depression, Siegel said. Narcotics do not treat these conditions, nor do they necessarily boost perceived quality of life.

“When asked about a pain score, level of function and daily activities, many people who rely on narcotics long-term remain at the same level and do not feel they are improving,” he said.

So what are the alternatives to powerful painkillers in treating chronic pain? We’ll provide some answers to that question in next week’s Monday Medical column.

Christine McKelvie is the public relations director at Yampa Valley Medical Center. She can be reached at christine.mckelvie@yvmc.org.

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