Pain Treatment FAQs

An individual with chronic disabling pain will naturally request pain killers, so why are some physicians reluctant to prescribe narcotics?

• For thousands of years, narcotic pain killers have been used for pain. When we break a bone, have a heart attack or after a surgery, it is comforting to know that these medications will relieve our pain and suffering. Similarly, for those dying from cancer narcotics can give excellent pain relief.
• Everyone seems to have an opinion on the use of narcotics for chronic pain. With the scale of prescription drug abuse in Missouri, most families are aware of someone who has been affected by this epidemic.
• There is no doubt that narcotics are effective in patients with acute pain or cancer related pain.
• There are no good quality studies to show that narcotic pain medications work in the long-term for musculoskeletal pain alone, but may be beneficial in combination with behavioral therapy, interventional techniques, and physical therapy.
• There are studies to indicate that narcotic pain medications can be effective in the short to mid-term for bone and joint pain. Such an indication might be for three months of pain control while awaiting a knee replacement.
• Research studies show that patients on chronic opiate therapy have increased depression, reduced function and decreased activity.

Opiates can cause multiple problems. We have highlighted some of the complications associated with opiate therapy in the sections that follow on addiction, tolerance, hyperesthesia and hyperalgesia, immune and hormonal changes, withdrawal and detoxification.

• Addiction
• Detoxification
• Hyperesthesia and Hyperalgesia
• Immune and Hormonal Changes
• Pseudoaddiction
• Withdrawal
• Tolerance

We may ask you to undergo psychological or psychiatric evaluation and/or counseling sessions because of your chronic pain. Chronic pain affects not only the body, but also the mind. It is beneficial to have someone to whom you can talk about the pain and its impact on your life. The therapist provides information to the pain management physician on the psychophysiological effects of the chronic pain. We provide psychophysiological therapy, family therapy, group and individual psychotherapy to assist in controlling and coping with the pain. Depending upon the cause and type of pain, as well as the type of therapy, we also sponsor community support groups in the St. Louis region. If you are considering a permanent implantable device, such as a Dorsal Column Stimulator (DCS) or Intrathecal Pump, we will require you to have psychological screening, to make certain you fulfill the criteria for implantation. Patient’s who have pre-existing psychiatric conditions such as bipolar disorder, borderline personality, schizophrenia, major depression, or any history of substance abuse should notify us immediately upon patient intake. Successful treatment of chronic pain in these particular patient groups depends upon a coordinated approach, especially in these specific conditions.

Pain medications are an important part of you care. We want to ensure that you are on an appropriate medication regimen for your specific pain. All patients who are prescribed narcotic pain medication must sign a narcotic agreement with The Center for Interventional Pain Management. This agreement is to ensure that we are the only physicians prescribing you pain medication, and that all narcotic pain medications are filled at a designated pharmacy. This will provide greater relief from the pain and also help prevent possible serious drug interactions. If you break this agreement, you will no longer be prescribed narcotic pain medication from the Center for Interventional Pain Management. The Center for Interventional Pain Management does not view running out of pain medication to be an emergency. You are responsible for taking your medication in the manner in which it is prescribed. No refills or medication changes will be given after hours, on weekend or holidays. Narcotic pain medications will not be refilled without physically seeing you in the office, on at least a monthly basis. Please remember, it is your responsibility to monitor your medication usage and to plan for your follow-up visit if you need a refill.

• Unless specifically stated otherwise, all prescriptions are written as a full thirty-day supply. If you have been prescribed a narcotic pain medication on an as needed basis, it must last you a full thirty days, the instructions on the bottle are the maximum permitted amounts, you should ration your medication to last a full thirty days.
• Don not take medications other than prescribed without consulting your health care providers. Even over the counter medications, such as Benadryl or Tylenol, can significantly interact with prescribed medications and cause serious complications.
• Do not combine sedatives or anti-anxiety medications with alcohol or with pain medications.
• Do not use pain medications as sleeping aids.
• Never give your pain medications to someone else.
• Do not suddenly stop taking your pain medications.
• Make a full list of all medications you are taking, including any over the counter medications or supplements, and bring this list with you to each appointment.
• Lock up all painkillers to keep them out of other people’s hands.