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HUNTINGTON, W.Va. (AP) — A whopping 100 million Americans suffer from chronic pain, and to manage that pain long-term, 5 million to 8 million use prescription opioids.
According to the Centers for Disease Control Policy, West Virginia is among the states that prescribe the most painkiller prescriptions, 138 per 100 people.
But it was not always that way.
A generation ago, doctors were wary about the use of opioids to manage common pain problems. That began to change in the 1990s as drugs such as OxyContin — touted to be less addictive — were introduced. Painkillers first used only for extreme cases, such as cancer patients near the end of life, became commonly prescribed for many types of chronic pain.
As the volume of pain-pill prescriptions rose so did addiction problems. Opioid overdoses in the United States have gone up 200 percent since 2000. In Cabell County, there were more than 900 overdoses in 2015, with 70 resulting in death.
Research is now showing opioid medication may not be an effective way to manage long-term pain, according to research published early last year in the Annals of Internal Medicine, and doctors at Cabell Huntington Hospital's Pain Management Center and St. Mary's Medical Center's Pain Relief Center say there are actually a lot of better, safer options for chronic pain sufferers.
Dr. Joseph DeLapa with Cabell Huntington's center said he doesn't think people realize there are different options, and he is trying to educate people about those options.
The most common types of chronic pain are neck pain, lower back pain, migraine headaches and knee/joint pain.
The first step at both centers is identifying the root cause of the pain. Dr. Rudy Malayil at the St. Mary's center said his mantra is "less is more."
"It's not just injections and pumps," Malayil said. "We try to see if the least amount can be done, like back braces, physical therapy, and try to use that first."
Other less invasive options are counseling and general lifestyle changes, DeLapa said.
"We are very strong advocates of lifestyle change," he said. "Stop smoking. Weight loss and increased activity can improve overall health but also overall pain."
The National Institutes for Health found pain is one of the leading reasons Americans are turning to complementary health approaches such as yoga, massage and meditation.
If those approaches aren't effective or won't be effective, there are minimally invasive procedures that can be performed, including nerve blockers, spinal injections, steroid injections and spinal cord stimulators. There is also a pump that can be inserted in the back that gives doses of medication, but because it is in the pump it practically eliminates the risk of abuse, Malayil said.
Both doctors said opioid pain medication is still sometimes the best option, but there are also non-opioid medications that can be used to treat pain, and opioid drugs are rarely the first option.
But pain medications are still highly prescribed across the state. A Center for Medicare and Medicaid Services mapping tool shows 6.06 percent of Medicaid Part D claims in the state are for opioids, above the national average of 5.32 percent. In Huntington, it's 7.18 percent of claims.
In 2008, West Virginia required all pharmacies to record prescribed opioids, which doctors have access to. Malayil said in most cases where high doses of opioids are being prescribed in the state, providers are not trained properly in pain management.
"That's a problem," he said.
He said he has had people in other parts of the state tell him they can't walk down the street without being asked to sell their medication.
The West Virginia Hospital Association Board of Trustees recently endorsed new provider-focused and provider-developed recommended guidelines for all West Virginia hospitals to address the misuse of opioid prescriptions.
The new guidelines consist of 10 principles that establish baseline recommendations for opioid screening, prescribing practices, and appropriate use of resources to work with patients prior to prescribing an opioid pain medication in a West Virginia hospital emergency department. The overall goal is to ensure that health care providers in West Virginia have current, standardized resources and tools to work with, and to educate patients on the risk of taking opioid medications.
The CDC is also working on a set of prescribing guidelines for opioid painkillers, which The Associated Press called the strongest government effort yet to reverse the rise in deadly overdoses tied to drugs like OxyContin and Vicodin.
The guidelines were expected out this month, but the CDC dropped that date after resistance from drug makers, industry-funded groups and even officials in the Food and Drug Administrative, which historically advises physicians on medications, not the CDC.
The guidelines have instead been open to public comment for 30 days and additional changes.
DeLapa said anyone who has been in pain for two or three months should consider making an appointment to see a pain management specialist.
Both doctors also said they often see patients who want to get off pain medicine or feel they are becoming dependent or addicted.
"We do not just prescribe medications," DeLapa said. "Our goal is to get them off of the medicine."
Delapa and his partner Dr. Ahmet Ozturk also direct patients to Cabell Huntington's Recovery Center, a comprehensive treatment program for patients with opiate addiction.
The final goal of pain management is to help the patient live a productive life again, he said.
Patients must be referred by their primary care doctor or other specialist to see both Cabell and St. Mary's doctors.
For more information about Cabell Huntington's Pain Management Center, call 304-526-2243 and for more information about St. Mary's Pain Relief Center, call 304-525-7246.
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Information from: The Herald-Dispatch, http://www.herald-dispatch.com
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