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Pain management physicians offer tips to help your patients
e-Reports, June 24, 2013
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The ISMA begins work with MLB on new pain management prescribing rules
This month, the ISMA will begin the formal process of working with the Medical Licensing Board of Indiana (MLB) to help draft the state’s first comprehensive pain management rules required by law (SEA 246).

In July, the board will hold hearings on the emergency proposed rules and will vote by its October meeting to adopt the rules, which will become effective Nov. 1, 2013.

Additionally, the MLB will be working to adopt an emergency rule. It will provide a process to receive, review and authorize a petition to examine records relating to an investigation of a physician’s prescribing practices by the Office of the Indiana Attorney General.

Following the emergency rules, the MLB must adopt a set of final rules to be signed by the governor by Nov. 1, 2014.

The number of deaths related to controlled substances has Indiana officials focused on physician prescribing practices. And several recent suspensions of physicians by the Medical Licensing Board of Indiana may encourage you to re-evaluate how you are treating patients with chronic pain.

To help you, the ISMA recently hosted a seminar in which leading pain management physicians offered successful methods for treating pain and addiction. Here are some of their suggestions.

Have a signed agreement
All guidelines support a signed agreement, according to Randall Stevens, M.D., who is board certified in family medicine and addiction medicine. He noted that the agreement document should address these issues:

  • Honesty about symptoms and medications
  • Discontinued use of illegal drugs
  • Not sharing, trading, selling or giving medication to anyone
  • Not accepting or obtaining any controlled medicine from another physician
  • Taking medicine as prescribed
  • Voluntarily submitting to a blood or urine test
  • Procedures to follow if medicine is lost or stolen

Dr. Stevens also commented that the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) program is a useful tool in reviewing a patient’s prescription history. The Indiana program now shares data with Ohio, Michigan, Illinois, Kentucky, Kansas, Arizona, Connecticut and North Dakota.

Read more about INSPECT at in.gov.

Integrate methods of care
Heading an integrative seven-week pain program at Wishard Health Services in Indianapolis, Palmer MacKie, M.D., has noticed that his patients have experienced significant decreases in pain and fatigue and large increases in activity through education. His program includes:

  • Progressive exercise, including aerobic, strength and range of motion
  • Massage therapy
  • Education
  • Acupuncture
  • Use of heat, TENS, ice
  • Relaxation response therapy
  • Cognitive behavioral therapy
  • Yoga
  • Hypnosis
  • Mindfulness meditation

“At best for chronic pain, opioids only provide 30-40 percent pain relief,” he explained. “Take time to get and give more information from patients. Help them understand what is going on and get them engaged,” said Dr. MacKie.

Treating addiction
Indianapolis pain physician Marc Duerden, M.D., has found success managing his patients’ chronic pain by using Buprenorphine therapy.

He advised screening patients at risk for opioid dependence by using a tool found here.

Dr. Duerden also advised using two simple tests to help you identify patterns of drug and alcohol abuse; find the tests here.

Watch for this seminar, “Responsible Pain Management Prescribing: Strategies for Everyday Practice,” to be available online soon on the ISMA education page.

Also, find the ISMA’s December seminar, “Responsible Pain Management Prescribing,” archived online at the ISMA website.

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