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Medication Management

Medication Management (1)

02 Nov

Advanced Pain Management (APM) is proud to be among the growing number of providers in this country working to reduce the number of opioid prescriptions given and, in doing so, prevent as many medication-related deaths as possible.  APM’s efforts align well with the recent CDC Guideline for Prescribing Opioids for Chronic Pain, which states, “Patients with pain should receive treatment that provides the greatest benefits relative to risks.”[1]

While in a majority of cases, this means nonopioid – and even nonpharmacological – therapy for the treatment of pain, there are certain circumstances where the benefits of opioids may outweigh the considerable risks. When this is the case, it’s imperative that risk-mitigating measures are put into place to ensure continued patient safety. At APM, this is referred to as medication management.

Deciding on Opioid Therapy

When a patient enters treatment at APM, our fellowship trained, board certified physicians take a complete medical history, in addition to completing a comprehensive patient consultation. During these steps, the physician will ascertain which treatments a patient has used and how they worked, the patient’s past and present usage of opioids and other medications, how their body uses pain medications and how they tolerate opioids.

In addition, a screener and opioid assessment will help the physician determine if the patient has any additional risk factors that may make long-term opioid therapy more dangerous, such as behavioral health issues or a personal or familial tendency toward addiction. Since opioid medications affect patients in different ways, honest answers to these questions will allow APM’s providers to best assess and treat each patient’s pain.

If a decision is made that opioid therapy is the right option for a patient, the physician will work with the patient, as recommended by the CDC,[1] to establish realistic goals regarding their pain and functional ability – like being able to walk around the block or sleep through the night without pain awakening them. Together, they will also discuss how and when the therapy will be discontinued if the benefits no longer outweigh the risks – for instance, if there is no increase in pain levels or the ability to function.

Risk-Mitigating Measures

If opioid therapy is warranted, every measure will be taken to reduce the risks associated with the medication. This includes prescribing opioids at the lowest possible dose necessary to achieve both pain relief and functional restoration. This may mean that patients currently on opioids will be tapered down to a more appropriate dose.

Patients taking part in APM’s medication management program are required to sign a controlled substance agreement, which outlines their responsibilities in regard to their medication, including taking their medication only as prescribed, avoiding alcohol and illegal drugs and keeping their medication safe and away from children.

The agreement also outlines other risk-mitigating measures that APM has in place, including urine drug testing and pill counts. Drug tests are completed for new patients and several times a year after that and allow providers to verify that individuals are using their medications as prescribed and not taking other medications or drugs that could be dangerous to their health. Pill counts work in a similar manner, ensuring that patients are taking their pills as prescribed and not skipping doses or taking them too often. Pill counts may be completed during or between appointments and provide another level of safety to protect patients from addiction, overdose and other negative side effects.

APM providers also check the Prescription Drug Monitoring Program,[2] a state database that lists patients’ names and the providers who have prescribed controlled substance to them, among other information. If any of the components of the controlled substance agreement are broken (for instance, if a random urine drug test comes back positive for an illegal substance), an APM provider may discontinue opioid therapy for that patient.

Interventional and Complimentary Treatments

The goal of medication management is for you to lead a more active lifestyle – but you will need more than just medication to make this happen. Opioids alone won’t take care of your pain. The CDC notes this, as well: “If opioids are used, they should be combined with nonpharmacologic therapy.”[1]

The types of therapies used will differ from patient to patient, depending on their pain type, medical history and other medical conditions. Oftentimes treatments will include a combination of interventional procedures (like steroid injections or nerve blocks), physical therapy, cognitive and behavioral therapy, smoking cessation, home exercise programs and complementary treatments like acupuncture. This focus on multiple therapies for the treatment of pain is known as a multimodal or multidisciplinary approach, which “can help reduce pain and improve function more effectively than single modalities,” according to the CDC.[1]

If you would like to learn more about APM’s personalized, multidisciplinary approach to treatment, give us a call at (888) 901-PAIN (7246) or schedule a consultation.

Download your free opioids and pain in-depth guide

[1] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[2] Wisconsin Department of Safety and Professional Services. Wisconsin Prescription Drug Monitoring Program (PDMP). Accessed June 02, 2016. http://dsps.wi.gov/pdmp/.

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