Passage of HB93 by the Ohio General Assembly last year was aimed at stopping the infamous “pill mills” operating in the state. Several, including two in the Dayton-Springfield area, have been closed and their owners prosecuted and sentenced to prison terms.

“These rogue physicians were doing this for cash — they were family docs seeing several hundred patients a day — for cash,” said Jeffrey Rogers, DO, of Orthopedic Associates of Southwestern Ohio.

Rogers is board-certified in pain management.

“Back early, when I was a resident, we thought we could control non-cancer pain with opiate narcotics,” Rogers continued. “We thought we could keep somebody with chronic back pain on some type of long-term narcotic forever.

“But then we realized that this tolerance began and the patient kept coming back every couple of months saying, ‘I need more.’ Possibly most of them were legitimate — they were trying to work harder and longer and they felt empowered that they could maintain their lifestyles.

“What happened was they become dependent on the medication and, all of a sudden, we felt uncomfortable writing it so they started getting it by illegal means off the street. People were getting it illegally off the street to treat the pain that we were under-treating because we were uncomfortable writing such large doses — even as pain physicians.”

But how do you treat pain without medications?

“The old tried-and-true ways of treating pain: physical therapy, diet, exercise, stopping smoking and lifestyle changes are all important,” said Amol Soin, MD, who founded and operates the Ohio Pain Clinic, which has four locations in southwestern Ohio. “Often times it’s more important than writing a prescription. We have been so quick to pull out a prescription pad, but a lot of simple remedies that have been known for centuries have been forgotten because of our ability to write a pill to treat something. We can actually use the body’s natural physiology to treat pain through things like lifestyle changes. Weight loss and exercise have also been very effective.”

“I think we greatly under- utilize physical therapy as a modality,” Rogers said. “I think that we, as Americans, look for the easy way out — just take a pill. We have become a pill-popping society.”

He said people also want pills for such conditions as depression, dieting and more.

“There are a lot of modalities out there: aqua-therapy, physical therapy and psychotherapy,” he said. “But there are problems. I honestly believe the patients when it comes to physical therapy with a $50 co-pay per visit and and we want them to go twice a week. Many don’t have $100 for physical therapy but, for four bucks, they can get a Vicodin script, so it becomes a true issue. Many patients cannot afford a lot of this stuff and that is what’s adding to this huge narcotic problem.”

Both physicians said that advances in technology are helping push past the medication issue.

“Advancement in nerve stimulation,” Soin said. “We now have the ability to isolate specific nerves that cause your pain and turn them off. That is done by placing a cuff electrode around the specific nerve, and then it’s attached to a stimulator box similar to a pacemaker.

“Before we used that mostly for back and leg pain but now we can use it for all sorts of pain like migraine headaches and even amputee pain and stuff like that,” he said.

Soin said the cuff is a few millimeters up to a centimeter in size.

“You identify the nerve and wrap that cuff around the nerve itself so it’s actually implanted,” he said. “We do that for a lot of amputations and phantom limb pain, which is just horribly debilitating.”

He said that the procedure requires only a small incision and allows continual access to the nerve.

“The patient can literally push a button and turn the nerve off — which is very nice,” he said.

Radio Frequency Ablation is another technique being used in pain management.

“We do a lot of it and we have very good success with it,” Rogers said. “What that entails is we put a special needle that gets very hot into the side of the nerve that is giving the sensory input from the (problem) joint. When you get that needle inside and heat it up, it coagulates the protein in the nerve and the nerve cannot transmit the pain signal to the brain.

“We are wiping out the sensory function of the nerve so there is no feeling from the joint but there is still mobility in the spine.”

“For back pain there is still that minimally invasive lumbar decompression. It’s a new procedure about a year-and-a-half old to treat spinal stenosis (a narrowing in and around the spinal canal that causes pressure on the nerve). We go in through two small pencil-point sized incisions and are able, under X-ray guidance, to pull out some of the bone to create more space,” Soin said.

“There has been a lot of new stuff coming out with the implantable pain pumps, and we are starting to use different medications — even ones that are not narcotic. We have started to mix local anesthetic in there,” he continued, explaining that the local anesthetic was similar to that a dentist uses when numbing a patient’s mouth.

“We use those same medicines inside the pump itself in a very low dose and have found that has a long-term numbing effect. So you are getting some pain relief without using narcotics.

“Some of the coming pumps have the ability for the patient to have their own remote programmer where they can push a button and actually adjust the dose as well. It does have a lockout feature so you can’t overdose but it is giving the patient a lot of freedom,” Soin said.

Rogers said his practice is focused on spine pain.

“We do a full evaluation including an (Magnetic Resonance Image),” he said. “A lot of these patients are suffering from mechanical low back pain. It’s either a disk or a facet joint. There are various interventional techniques that we can do like injecting the facet joints with some steroids to try to relieve the pain. If it’s a disk, then injecting around the disk that is pushing on the nerve will alleviate the pressure which would then alleviate the leg pain.”

Both physicians talked about other techniques for alleviation of pain without the use of dangerous narcotic medication.

For more information:

www.ohiopainclinic.com

www.oaswo.com