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Pain Management and PDMPs

Safe and lawful prescribing of pharmaceuticals are the aim of Prescription Drug Monitoring Programs (PDMPs). However, a delicate balance must be struck. Learn more here.

What are PDMPs?

Prescription Drug Monitoring Programs (PDMPs) attempt to ensure the safe and lawful prescribing of pharmaceuticals through networked databases of physician practices, hospital systems and pharmacies that allow for automated controls on how controlled substances are prescribed to patients.

Typically these systems are implemented and maintained at the state-level, with 49 U.S. States, the District of Columbia and Guam currently operating PDMPs.

A key function of these systems is to combat issues surrounding the misuse of opioids. While proven an effective therapy for managing chronic pain, opioids have addictive properties and can be dangerous in large quantities, or when mixed with certain kinds of medication.

Benefits of PDMPs

As PDMPs become more ubiquitous throughout the U.S., and data comes in, encouraging statistics have emerged. According to the CDC, in Florida, opioid-related deaths fell 50% from 2010 to 2012, when pain clinic regulations and the establishment of a PDMP was put in place. The CDC also reported a 75% decrease in doctor shopping (seeking multiple prescriptions for opioids from different doctors) from 2012 to 2013, when New York began requiring prescribers to check the PDMP before writing painkiller prescriptions.

Major benefits of PDMPs include:

  • Reduction in overprescription of opioids
  • Reduction in doctor shopping
  • Avoid harmful drug interactions
  • Reduction in fraudulent prescriptions
  • Improved quality of care
  • Enhanced treatment and intervention for patients with or developing dependencies
  • Increased confidence in prescribing painkillers
  • Capturing geographic trends and other data points to improve population health

Concerns Among Physicians and Patients

With any disruptive integration of technology in medicine there are drawbacks, especially where there are potential legal consequences at stake. Physicians are becoming wary of being identified as over prescribers of opioid medicine, and may withdraw from using the therapy where it has a legitimate use. This is also known as “the chilling effect” which can lead to patients being underserved, or receiving alternative treatments that could have greater side-effects or are less effective. This is especially true of pain management providers who specialize in such therapies, and are relatively high prescribers of opioids.

Some other  potential drawbacks PDMPs pose are:

  • Fear of undue legal scrutiny for patients and physicians
  • Less effective pain management therapies
  • Reduction in precision care/increase in inadequate care
  • The wrongful identification of addicts or “pseudo-addicts”
  • Privacy concerns
  • Wrongful categorization as fraudulent prescribers
  • Increased time demands for physicians
  • Lack of ability to illegal drug use, such as heroin

What Pain Management Care Providers Need to Know

Because there is no accurate way to measure pain, other than what is reported from patients, physicians must rely on radiology, historical information, laboratory tests, and physical examination to make a judgment on the appropriate treatment.

This presents a fine line that pain management care providers must walk.

There is an element of accuracy that PDMPs can provide in determining the most effective intervention for either pain management or drug dependency by using their data. However, addiction from illicit drug use and dependence due to pain management can require different methods of intervention and treatment. Addiction treatments are currently largely geared more towards illicit drug users. This presents a challenge in striking an effective balance of curbing risks of drug dependency while not reducing effective pain treatment.

Being a part of a network can help alleviate some of the time and effort needed to navigate this complicated balance. PDMPs will likely expand in use and effectiveness over the coming years. As they do, so will the possibility of safely prescribing powerful medications while adequately treating pain.

Chronic pain sufferers will try almost anything to achieve relief from their pain symptoms. Typically the first line of defense are various pain medications, both over-the-counter and prescribed by a physician.

However, pain medication cannot be guaranteed to always work as prescribed or as intended. Over the years medical research has revealed that not every person absorbs medication the same ways, and that over time our body will change how it reacts to medications.

Pain physicians have a number of ways to combat this issue in patients.

“This is a situation known as tachyphylaxis where more medication is needed to achieve the same effect,” said Dr. Rodolfo Gari, Tampa pain specialist with Florida Pain Relief Group. “Many believe that tachyphylaxis occurs because our bodies increase the number of receptors necessary to achieve pain control and therefore more medication is needed to achieve the same effect.”

Typically a patient does not want to increase their existing medication dosages, but instead find a combination or approach that works best.

“A way to counter this without increasing dosage is to switch the medication to a different class of opioid that works in different receptors,” Dr. Gari said. “For example, switching from hydrocodone to oxycodone or switching from morphine to methadone for a short period of time can restore the original effect. We can then switch back to the original medication with better results at a lower dosage.”

For patients who don’t experience relief from a change in medications may be good candidates for a test called Pharmacogenomics. This test will help a doctor to prescribe medication based on more than symptoms.

“Pharmacogenomics is a field of medicine that matches our unique genetic make up with the medications that work best for us,” Dr. Gari said. “We have all experienced ‘trials’ of different medications until we find one that works. Pharmacogenomics allows us to use the right medication the first time.”

All of our pain doctors in Tampa offer pharmacogenomics testing to their patients. Schedule an appointment at any of our Tampa pain relief centers in East Tampa, North Tampa and Carrollwood.