Practice philosophy

[bronchospasm]

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Here is a copy of our practice philosophy.

Sent to all new patients. As well as reinforced when necessary.

Our philosophy: Multidisciplinary approach to Pain Management

We believe that successful pain management therapy requires that we first identify the cause and then utilize appropriate therapies to target the cause of the pain. Research shows there is no “one size fits all” for pain management, instead, we have to target the cause of the pain from multiple directions.

We have identified the following core methods that have proven to be effective in treating pain.
1. Patient Education
2. Home Exercise Program
3. Physical Therapy
4. Interventional Therapies that target the cause of pain
5. Medication that target nerve pain, muscle relaxants, antiinflammatories
6. Treatment of depression, if present.
7. Advanced Therapies like Radiofrequency and Spinal Cord Stimulation
8. Opioid Medications to be used along with other treatment modalities if necessary.

Our Goal is to use proven, evidence based techniques to target and treat various pain disorders so that you can lead a pain free, productive lifestyle without reliance on addicting narcotic pain medications alone.

Appreciate any inputs to improve this??

 

[gdub25]

"So that you can lead a pain free, productive lifestyle..."

I'm always careful to tell patients it's important to have expectations set correctly from the beginning, and that there is very little chance we can make them pain free. We help them manage their pain, get them functioning better, but probably not gonna be pain free.

 

[lobelsteve]

Leave off opiates on the page. My eyes found it first and i didnt get to read any of that touchy feely crap.

 

[drusso]

Leave off opiates on the page. My eyes found it first and i didnt get to read any of that touchy feely crap.

I disagree. It's the 800 pound Gorilla in the exam room. "You've got to name it to tame it." We post this liberally in our exam rooms, new patient paperwork, website...before I walk in the room they know what they're going to hear. If they have questions, I just point to the framed version on the wall.

Opioid Therapy Statement

The physicians at Columbia Pain Management, PC are here to change your life by reducing your pain and improving your daily functioning. We do this with safe and effective comprehensive treatment plans that reduce risks and maximize benefits.

We go to great lengths to protect our patients from the significant risks that are associated with opioid therapy which are also known as narcotic medications. We stringently follow DEA and other professional society recommendations regarding prescribing opioid medications. Further, we only prescribe opioid medications if we determine that a patient’s pathology warrants their use, the patient satisfies specific criteria, the patient has failed other lower risk treatment options, and that there is a reasonable expectation for prolonged functional improvement.

We typically do not prescribe high doses of opioid medications as research continues to show that this regimen has much greater risks for patients with few long-term benefits as compared to lower doses. We believe that if you suffer from pain, we can help you. We successfully treat all types of pain with our comprehensive treatment plans. Our treatments are safe, minimally invasive, and clinically proven to be highly effective.

Long-term Effectiveness of Opioids for Chronic Pain
Opioids offer an appropriate and safe treatment for some but not all patients with non-malignant chronic pain. Patients on opioid therapy for chronic pain require close monitoring and surveillance to assess for functional benefits and minimization of harm. Most patients who trial opioid medications for long-term pain discontinue them due to lack of efficacy or side effects. No treatment should be continued without benefit.

More evidence is available on harms of long-term opioid therapy than benefits. Controlled observational studies suggest that, compared with no opioid use, opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse and dependence, addiction, fractures, myocardial infarction, and use of medications to treat sexual dysfunction. Some forms of opioid medications may be safer to use than others in certain circumstances. The use of opioid medications in combination with other sedating or centrally-acting drugs is considered dangerous and potentially life-threatening.

 

[Aether2000]

Love it Drusso!

 

[101N]

I think it's good that you are thinking about this. Going through this process creates your mission statement. I'd agree with Steve's advice about the opioids. Also, with chronic non-cancer pain treatment outcome is heavily influenced by
by patient factors that are beyond physician control: catastrophizing, pending litigation, disability-seeking, drug seeking/dependency. Thus, for full disclosure, there needs to be some mention of the requirement for the patient to bring realistic expectations treatment. The fact is chronic pain cannot be cured.

1. http://www.ncbi.nlm.nih.gov/pubmed/26447703
2. http://www.ncbi.nlm.nih.gov/pubmed/26375824
3. http://www.ncbi.nlm.nih.gov/pubmed/26125059

 

[drusso]

I think it's good that you are thinking about this. Going through this process creates your mission statement. I'd agree with Steve's advice about the opioids. Also, with chronic non-cancer pain treatment outcome is heavily influenced by
by patient factors that are beyond physician control: catastrophizing, pending litigation, disability-seeking, drug seeking/dependency. Thus, for full disclosure, there needs to be some mention of the requirement for the patient to bring realistic expectations treatment. The fact is chronic pain cannot be cured.

1. http://www.ncbi.nlm.nih.gov/pubmed/26447703
2. http://www.ncbi.nlm.nih.gov/pubmed/26375824
3. http://www.ncbi.nlm.nih.gov/pubmed/26125059

The matter of fact is that you have to do both. People come to pain clinics for only two reasons: Hydrocodone & Hugs.

I frame expectations early (the first medical visit or behavioral health screening visit) about what *IS* pain management and what it *IS NOT.* Opioids are only one tool for specific kinds of patients and pain problems. Being up front, transparent, and establishing this early saves a lot of work (and potentially lives) down the line.

Part trois from the above.

Chronic Pain
Chronic pain occurs when changes in our nervous system cause ongoing painful sensations beyond the expected time of tissue healing. Most chronic pain begins following an injury, tissue destructive disease, or surgical procedure. Too many people believe that they are condemned to suffer with chronic pain.

You’re not alone. In fact, some estimates place the burden of chronic pain at over 100 million Americans. The good news is that there are a variety of treatments available, to help you live a better life despite your pain. Effective pain management uses multiple approaches (pharmacological, interventional, and behavioral) to reduce pain, alleviate suffering, and restore function.

Grounded in a physiatric (physical medicine and rehabilitation) model of care, the specialists at Columbia Pain Management, PC are committed to helping you get your life back and help you do the things you want to do despite pain. Whether it’s degenerative joint disease, spinal arthritis, or pain caused by nerve damage, one of the specialists at Columbia Pain Management, PC can meet with you and help you discover what options might be best for your condition.

 

[Jcm800]

or just tell em you dont prescribe opiates, because they really dont work long term for chronic pain...

but hey, thats bad for business right?

 

[Ducttape]

I like your statement, drusso, however.....

when i read your statement, while accurate, i can only envision patients thinking "well, he's not talking about me. I wont have those problems. And what this means is if i keep telling me how i NEED these drugs to FUNCTION, he'll break down and give them to me. Every Other doctor has given them - and i wont mess up this time."

Also, most of the patients i see can only read "twitter-ese"... Esp when it cones to length

 

[bronchospasm]

I disagree. It's the 800 pound Gorilla in the exam room. "You've got to name it to tame it." We post this liberally in our exam rooms, new patient paperwork, website...before I walk in the room they know what they're going to hear. If they have questions, I just point to the framed version on the wall.

Opioid Therapy Statement

The physicians at Columbia Pain Management, PC are here to change your life by reducing your pain and improving your daily functioning. We do this with safe and effective comprehensive treatment plans that reduce risks and maximize benefits.

We go to great lengths to protect our patients from the significant risks that are associated with opioid therapy which are also known as narcotic medications. We stringently follow DEA and other professional society recommendations regarding prescribing opioid medications. Further, we only prescribe opioid medications if we determine that a patient’s pathology warrants their use, the patient satisfies specific criteria, the patient has failed other lower risk treatment options, and that there is a reasonable expectation for prolonged functional improvement.

We typically do not prescribe high doses of opioid medications as research continues to show that this regimen has much greater risks for patients with few long-term benefits as compared to lower doses. We believe that if you suffer from pain, we can help you. We successfully treat all types of pain with our comprehensive treatment plans. Our treatments are safe, minimally invasive, and clinically proven to be highly effective.

Long-term Effectiveness of Opioids for Chronic Pain
Opioids offer an appropriate and safe treatment for some but not all patients with non-malignant chronic pain. Patients on opioid therapy for chronic pain require close monitoring and surveillance to assess for functional benefits and minimization of harm. Most patients who trial opioid medications for long-term pain discontinue them due to lack of efficacy or side effects. No treatment should be continued without benefit.

More evidence is available on harms of long-term opioid therapy than benefits. Controlled observational studies suggest that, compared with no opioid use, opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse and dependence, addiction, fractures, myocardial infarction, and use of medications to treat sexual dysfunction. Some forms of opioid medications may be safer to use than others in certain circumstances. The use of opioid medications in combination with other sedating or centrally-acting drugs is considered dangerous and potentially life-threatening.

Love it.....

 

[bronchospasm]

I like your statement, drusso, however.....

when i read your statement, while accurate, i can only envision patients thinking "well, he's not talking about me. I wont have those problems. And what this means is if i keep telling me how i NEED these drugs to FUNCTION, he'll break down and give them to me. Every Other doctor has given them - and i wont mess up this time."

Also, most of the patients i see can only read "twitter-ese"... Esp when it cones to length

The moment I get a patient who mentions the key words like "need pain meds to function" "improved quality of life" ...

Coached patient. Red flag.

 

[drusso]

I like your statement, drusso, however.....

when i read your statement, while accurate, i can only envision patients thinking "well, he's not talking about me. I wont have those problems. And what this means is if i keep telling me how i NEED these drugs to FUNCTION, he'll break down and give them to me. Every Other doctor has given them - and i wont mess up this time."

Also, most of the patients i see can only read "twitter-ese"... Esp when it cones to length

It's not negotiable. You can't let YOUR thinking become distorted by your patients' thinking. "How do you need to function?" "Is there anything you can do WITHOUT pain meds?" These conversations take a lot of time and often occur over multiple visits. What's the rush? If you administratively establish that you don't RX on the first visit, then you have TIME to discuss these issues. No one dies of opioid withdrawal...

One useful resource our group uses (and practices using) is the "cognitive distortions checklist." When any provider walks out the exam room, they can pull someone aside and go through the list. Sometimes, it helps to "bring a buddy" back into the room and start the discussion in front the patient and (usually) a behavioralist (warm hand-off).

You'll be amazed at how just having a second set ears in the room CHANGES what patients will say. It's not unusual for my PA or NP to present a case and then say, "You know, when they talk about their pain or med use there's a lot "fortune-telling," "catastrophizing," and "blaming." Maybe you can help me re-frame that kind of thinking of for them?

Ultimately, there is only so much you can do. But, by helping your patients THINK more accurately about their pain, their life experiences, and their future you can help them BE more accurate about their pain, life experience, and future. It's not all kyphos and stims around my office, but getting good at this (either independently or within a team) is what is needed for the next 20 years of practice. Good time to start is now.

http://www.apsu.edu/sites/apsu.edu/files/counseling/COGNITIVE_0.pdf

http://annkoplow.com/2013/02/10/handout-on-cognitive-distortions/

 

[Ducttape]

Im not disagreeing with you, drusso, even though it might appear that i am. I think im approaching it slightly differently, more dumbed down as it were.

Patients are told that we do not prescribe opioids for nonmalignant pain, and are presented with multidisciplinary options. Esp Mental health assistance (working on in office CBT, but a long haul... )

Later on, after several visits, if appropriately vetted and i determine that there may be value with regards to an established level of functionality, towards adding low dose tramadol or nucynta or MED< 30 to the regimen, then a discussion may commence. Unless their past prevents this.

I try to set the expectation this way that the opioids are only a small component and not a vital one at all. The feeling i get is that the more patients hear about opioids, the more they want them...

 

[gotname]

We have identified the following core methods that have proven to be effective in treating pain.
1. Patient Education
2. Home Exercise Program

It seems that a lot of people become defensive (or take the "it doesn't apply to me route) in regards to 'exercise' but will have no problem following the weird dude who asks them to do the same with his "Lifestyle Management" blog/dvds or "Wellness Program".

Exercise, better sleeping & eating habits can perhaps be combined as such.

Just a thought.

 

[bronchospasm]

Im not disagreeing with you, drusso, even though it might appear that i am. I think im approaching it slightly differently, more dumbed down as it were.

Patients are told that we do not prescribe opioids for nonmalignant pain, and are presented with multidisciplinary options. Esp Mental health assistance (working on in office CBT, but a long haul... )

Later on, after several visits, if appropriately vetted and i determine that there may be value with regards to an established level of functionality, towards adding low dose tramadol or nucynta or MED< 30 to the regimen, then a discussion may commence. Unless their past prevents this.

I try to set the expectation this way that the opioids are only a small component and not a vital one at all. The feeling i get is that the more patients hear about opioids, the more they want them...

I usually do not discuss opioids during the first visit unless there is an acute herniation and patient needs ESI and maybe 1-2 weeks of opioids.

 

[Papa Lou]

Leave off opiates on the page. My eyes found it first and i didnt get to read any of that touchy feely crap.

If you leave it off, as opposed to putting it last, it makes it even more prominent. Almost like "it goes without saying." I leave medicaid off my list for marketing purposes, but obviously I will take it like most other docs do. "it goes without saying."

I like having opioids dead last. It's a great message. Gotta go through the first 7 until you're left with number 8.

 

[Papa Lou]

I disagree. It's the 800 pound Gorilla in the exam room. "You've got to name it to tame it." We post this liberally in our exam rooms, new patient paperwork, website...before I walk in the room they know what they're going to hear. If they have questions, I just point to the framed version on the wall.

Opioid Therapy Statement

The physicians at Columbia Pain Management, PC are here to change your life by reducing your pain and improving your daily functioning. We do this with safe and effective comprehensive treatment plans that reduce risks and maximize benefits.

We go to great lengths to protect our patients from the significant risks that are associated with opioid therapy which are also known as narcotic medications. We stringently follow DEA and other professional society recommendations regarding prescribing opioid medications. Further, we only prescribe opioid medications if we determine that a patient’s pathology warrants their use, the patient satisfies specific criteria, the patient has failed other lower risk treatment options, and that there is a reasonable expectation for prolonged functional improvement.

We typically do not prescribe high doses of opioid medications as research continues to show that this regimen has much greater risks for patients with few long-term benefits as compared to lower doses. We believe that if you suffer from pain, we can help you. We successfully treat all types of pain with our comprehensive treatment plans. Our treatments are safe, minimally invasive, and clinically proven to be highly effective.

Long-term Effectiveness of Opioids for Chronic Pain
Opioids offer an appropriate and safe treatment for some but not all patients with non-malignant chronic pain. Patients on opioid therapy for chronic pain require close monitoring and surveillance to assess for functional benefits and minimization of harm. Most patients who trial opioid medications for long-term pain discontinue them due to lack of efficacy or side effects. No treatment should be continued without benefit.

More evidence is available on harms of long-term opioid therapy than benefits. Controlled observational studies suggest that, compared with no opioid use, opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse and dependence, addiction, fractures, myocardial infarction, and use of medications to treat sexual dysfunction. Some forms of opioid medications may be safer to use than others in certain circumstances. The use of opioid medications in combination with other sedating or centrally-acting drugs is considered dangerous and potentially life-threatening.

I am copying this and using in my clinic. Thanks this is fantastic!

 

[Papa Lou]

I think it's good that you are thinking about this. Going through this process creates your mission statement. I'd agree with Steve's advice about the opioids. Also, with chronic non-cancer pain treatment outcome is heavily influenced by
by patient factors that are beyond physician control: catastrophizing, pending litigation, disability-seeking, drug seeking/dependency. Thus, for full disclosure, there needs to be some mention of the requirement for the patient to bring realistic expectations treatment. The fact is chronic pain cannot be cured.

1. http://www.ncbi.nlm.nih.gov/pubmed/26447703
2. http://www.ncbi.nlm.nih.gov/pubmed/26375824
3. http://www.ncbi.nlm.nih.gov/pubmed/26125059

Thanks for this as well. I appreciate your contributions.

 

[lobelsteve]

If you leave it off, as opposed to putting it last, it makes it even more prominent. Almost like "it goes without saying." I leave medicaid off my list for marketing purposes, but obviously I will take it like most other docs do. "it goes without saying."

I like having opioids dead last. It's a great message. Gotta go through the first 7 until you're left with number 8.

If i was a patient i could find only 1 word on your page. My eyes drawn to it.

 

[Yo GabbaPentin]

#8 reads to patients as "you are guaranteed opioids of your choosing no matter what."

They see what they want to see.

 

[101N]

Don't mention opioids. Doing so perpetuates the myth that they are the 'final common pathway' for CNP, i.e., "But I tried PT, acupuncture, weight loss, NSAIDS, hypnotherapy, rolfing, naturopathy, chiropractic, coffee-enemas, tantric-dancing, crystals, craniosacral, herbs, homeopathy, CBT, ACT, Operant Conditioning!" I've earned the oxycontin. Sorry, nope.