Make Pain a Thing of the Past – #opioidcrisis #Naloxone #Bradenton #Florida #painmanagment – Physician Partners of America

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PPOA leaders represent pain physicians on panel

The scope of the opioid epidemic and new solutions took center stage at a live “Opioid Crisis Town Hall” special, sponsored by cable stations Spectrum Bay News 9 and Spectrum News 13 in Bradenton, Fla. on May 22.

Physician Partners of America (PPOA) founder Rodolfo Gari, M.D., MBA, and Chief Medical Officer Abraham Rivera, M.D., were the only pain management physicians chosen to participate on the panel. It drew more than 700,000 viewers.

Dr. Rivera explained how opioids have been used in one form or another for thousands of years, and people must not forget that they’re used because they work.

“In the acute [pain] setting, they are phenomenal drugs. After that, the patient gets hooked on them. They’re extremely addictive,” he told the audience.

Acute pain is discomfort lasting no more than 3 to 6 months, and it is usually related directly to soft tissue damage such as a sprain or surgery.

Also on hand were an emergency room professor, local law enforcement leaders, an advocacy group representative, and State Rep. Jim Boyd (R-District 71). A live audience was invited to listen in and ask questions.

The one-hour Opioid Crisis Town Hall was moderated by Bay News 9 anchor Veronica Cintron, and covered a wide range of topics related to new Florida opioid legislation. As of July 1, the law puts a three-day limit on most opioid prescriptions for acute pain. This does not apply to all patients, including those who live with certain chronic pain conditions.

The new Florida law funds $65 million for the treatment of addiction and includes providing the overdose-reversal drug Naloxone to first responders. While not providing as much funding as the bill’s champions had hoped, stakeholders applaud the policy direction.

Preventing opioid addiction through intervention

Drs. Gari and Rivera addressed the need to stop opioid addiction from happening. As interventional pain management specialists, Physician Partners of America providers get to the root of pain and treat it through various pain blocking procedures and minimally invasive techniques. Opioids are not the preferred course of treatment, but each patient’s condition is handled on a case-by-case basis.

“One of the things we can do to help this epidemic is to markedly decrease the number of customers that go to these treatment centers,” Dr. Gari said. “We can help patients but it’s going to take physicians that are serious about this and understand there are a lot of options that patients can have other than opioids.”

First-hand stories of addiction played a prominent role in the town hall and a preceding documentary. One Bradenton woman told an emotional story of how a car accident resulted in her addiction to opioids. Now drug-free, she described how she innocently got hooked after a doctor gave her a large supply of an opioid painkiller.

Dr. Rivera, touting the benefits of interventional care, told the audience, “Had that girl seen a pain specialist three days after she had her accident, she would never have fallen victim to opiates.”

Addressing fake pain

Both Drs. Gari and Rivera acknowledged that one of the thornier problems faced by physicians in the opioid crisis is determining who is a legitimate pain patient and who is doctor-shopping or faking discomfort. Pain doctors report seeing more people who claim their meds were stolen to get a new prescription.

“When a patient comes to me and they tell me their medication gets stolen, I treat that with a high degree of skepticism …I ask them for a police report,” Rivera said.  In suspicious cases, he offers a three-day supply of painkillers, requires immediate and frequent follow-up urine tests, and asks such patients to show him their unused portion.

Responding to questions about victim-blaming, the doctors explained PPOA’s drug-tapering protocol for new patients who are opioid-dependent.

As Dr. Gari told the Opioid Crisis Town Hall audience, “We treat our patients like they’re a family and like they’re our kids …you’re going to treat your kids with what you think your kid needs. It may not be always what your kids want… it’s what he needs, but you have to have these conversations.”

Patients should see a pain specialist

Noting that many patients visit their primary care providers for pain conditions, Dr. Gari stressed the benefits of early treatment by a board-certified pain management specialist. “A primary care physician would not be prescribing chemotherapy for a cancer patient,” he said. “So I believe [pain management] needs to be done by specialists that only treat pain.”

State Rep. Boyd, who praised PPOA leadership for supporting funding efforts for the opioid issue, agreed. Turning to Drs. Gari and Rivera, he told the Opioid Crisis Town Hall audience, “These are the professionals that should be prescribing that.”

Five easy steps to create a strong doctor-patient bond in the initial visit.

The relationship between doctor and patient continues to be the keystone in quality medical care. When a trusting healthy relationship is fostered initially, it is more readily maintained and set up for further growth. Quality relationships lead to an accurate description of symptoms, full medical history disclosure, and ultimately a more holistic view of the patient.

  1. Obtain Patient Consent

Obtain patient consent at every possible opportunity and work to maintain this mutual respect in which the patient feels autonomy over their own body. Frame things in a question as opposed to predetermined steps.

The simple act of asking permission rather than telling the patient what you are going to do immediately puts them at ease and makes them feel like a valued stakeholder in their own health.

2. Poker Face

Check your personal opinions at the door. While you may encounter patients that engage in unsafe or otherwise alarming behaviors it is not your job to pass judgment. Remain outwardly neutral as you explain the risks of a given activity and always appeal logically as opposed to emotionally. The moment you show your emotions on your face your patient will feel defensive and the trust that has been built in this short time will have already been broken.

3. Eye Contact

This one is easy! Keep your eyes on the patient as frequently as possible. If you are not engaged with your patient they will not engage with you. Eye contact is another way to help the patient feel valued and it reflects good listening skills when you are focused on your patient as they speak.

4. Assume Ability

Remember by now you know to check your judgments at the door so don’t stop at physical and mental ability. If you have a patient who appears to be differently abled, elderly, or young do not gloss over important questions you assume don’t apply to that patient. Your patient will notice, and the trust you have otherwise established will be damaged.

5. Simplify your Words

You have heard this one before; don’t spew medical jargon! While that is an important lesson let’s take it one step further and challenge you to be concise. If you lecture or over explain to your patient they will tune you out. Remember this is not your appointment this is about the patient. Making them feel important in their personal health will also motivate them to make healthy choices and continue to seek your input as well.