• Dorsal root ganglion (DRG) stimulation: The Axium™ Neurostimulator System is a new FDA-approved device that stimulates the DRG (a spinal structure densely populated with sensory nerves), providing pain relief to targeted areas of the body.
• Endomorphins: Tulane University researchers are developing a new painkiller that targets the same pain-relieving opioid receptor as morphine but is not addictive.
• Marijuana: A Harvard-led review of studies on the use of cannabinoids by pain patients found significant improvement in symptoms.
• Psychotherapy: Therapies including Cognitive Behavior Therapy work to improve quality of life and build coping mechanisms so pain becomes more tolerable.
In his annual State of the State address in January, Governor Doug Ducey announced he had sent a letter to the Arizona Medical Board and Arizona Board of Osteopathic Examiners recommending that doctors complete Continuing Medical Education (CME) in drug addiction to combat rampant opioid abuse. Many Phoenix-area doctors say this one-hour course (as part of the 40 CME hours required every two years) will be a step in the right direction, albeit a small one, for physicians to better address addiction and the slippery slope of over-reliance on prescription pain pills. The bigger issue, some say, is how we address pain in the first place.
“We created a culture where people have the impression that they should have no pain, because that’s what we told people for a long time,” says Dr. Bentley Bobrow, a professor of emergency medicine at the University of Arizona College of Medicine – Phoenix and chief medical officer of
ThePainProject.com. Over the last decade or so, he says, “we tried to treat every single kind of pain, and we over-treated it. And we inadvertently helped people become dependent on medication and surgeries.”
According to the Arizona Department of Health Services, on average, one person dies every day in the state from an overdose of prescription pain relievers – opioids such as Oxycodone and Vicodin that, like heroin, work by attaching to receptors in the brain and blocking the experience of pain. These pills are prescribed for all types of ailments, Bobrow says, often appropriately for acute pain associated with surgical recovery, broken bones, etc., but also for chronic pain that may not have a direct diagnosis. “When you see a doctor and do the tests and they don’t find anything wrong with your back or knee… then they give you a prescription,” he says.
Despite their potency and potential for abuse, many doctors receive little to no formal training on how to properly prescribe these drugs. Dr. Frank LoVecchio, an emergency medicine specialist at Banner University Medical Center Phoenix, says he had “almost none” and points out that many medical schools have only started incorporating education on addiction and opioids into curriculums in the last year.
Another issue is over-prescribing. Dr. Eric Feldman, an interventional spine physician with The CORE Institute in Phoenix, says though the vast majority of doctors have good intentions, many prescribe way too many opioid pills to patients who have had routine procedures or surgeries: “Instead of giving them 14 Percocets, they give [patients] 50… you take five after [surgery] and now you have 45 [pills] in your medicine cabinet.”
Dr. Minesh Zaveri, medical director at St. Luke’s Medical Center, says Ducey’s executive action to get physicians trained is a good start, but “we still need to address underlying issues.” Pain – especially chronic pain – is not easily fixable, he says, so it follows that pain pills aren’t a magic fix. “Society wants relief right away, but what is the source of why you’re having a problem?” he asks.
Dr. Bobrow says medical training needs to shift from the biomedical model – “what you can see, what you can quantify” – to the biopsychosocial – biological factors in addition to psychological and social factors. “All of these things together are what form our experience of pain,” he says.
Addressing pain will require a better grasp on addiction, Bobrow says, but it will also require a deeper understanding of mental health and societal trends. That’s a tall order, and one that seems impossible to cover fully in Ducey’s order for a one-hour course. “We’re trying to fish people out of the river when they’re floating by when they’re addicted,” Bobrow says. “What we really need to do is go upstream and figure out why people are falling into the river in the first place.”
Click here to read print edition: PhoenixMagazine_April2017_Zaveri