HJAR Jan/Feb 2021

20 JAN / FEB 2021 I  HEALTHCARE JOURNAL OF ARKANSAS PAIN MANAGEMENT referring to the use of stem cell therapy. I feel there is a lot of potential in the use of regenerative medicine for the treatment of osteoarthritis conditions and conditions of the discs. Many of my colleagues around the country are actively working to discover which regen- erative treatments work for certain condi- tions. I don’t think that we have the answers at the current time, but I believe that in the upcoming years, we will have dramatically more knowledge about the effectiveness of these treatments, and they will be more gen- erally available to the public. OLAYA: I have not practiced regenerative medicine; I have minimal experience about it – only what I have heard – but, yes, some of the doctors at Arkansas Spine and Pain have used this kind of medicine with the intention to regenerate and diminish the inflamma- tory process. Much has been written about the mind-body connections of pain, where uncomfortable thoughts trigger pain in certain points of the body. What are your thoughts on this? GOREE: I 100% believe that we have to treat the holistic patient. While we often focus on “pain,” pain is just one aspect of quality of life. Our quality of life is affected by so many more factors, including our surroundings, our access to basic needs, our psychological state, level of activity, nutrition, etc. As we assess our patients, we need to assess more than just their pain history. We need to fully understand how this is affecting their qual- ity of life and create a holistic plan for them, addressing not just their pain, but also other deficits. This will allow our patients to live more happy, active and productive lives. OLAYA: Central pain like the one that can trigger fibromyalgia or peripheral sensitiza- tion like myofascial pain can be aggravated by states of stress, anxiety, depression, the need for attention and secondary valida- tion among others. When a person is in a state of stress, several chemical mediators are released that cause muscle tension, pro- mote inflammation and pain. Therefore, an integrated approach with the help of a pain physician combined with physical therapy and a psychologist are paramount to treating these difficult conditions that affect a good percentage of patients in pain. It has been observed that relaxation techniques, occu- pational therapy and exercise (Tai Chi as an example) can be great adjuvants in helping the patients to cope with this kind of pain. Pain has been linked to the opioid crisis in the U.S. Do you think that is accurate? Do you think it is a crisis? And if so, what can be done to stop it? GOREE: We have both an opioid crisis and a pain crisis. The opioid crisis is that the use and abuse of opioids is killing tens of thou- sands ofAmericans every year. Unfortunately, many of these patients truly have chronic pain, and they do not have access to effective therapies for chronic pain. The solution is twofold: 1. We must ensure that patients have ac- cess to high quality chronic pain care. This includes educating our practitio- ners about the risks of opioids and the use of other nonopioid options and en- suring that we have well-trained spe- cialty providers who can provide op- tions for advanced cases; 1. We must recognize when patients are at risk of opioid use disorder and treat them appropriately. Included in this is the normalization of Narcan, the rescue drug for opioid overdose. This should be readily available so that lives can be saved. OLAYA: This is a very complex question with a lot of implications and angles. However, yes, it is true there is a crisis and that pain has been used as an excuse to go to a pain clinic to access opiates. Even when opiates are used appropriately and justifiably, they can un- mask an addictive tendency in some patients. The reason we are in this crisis has several additional factors: the inaccurate marketing of Oxycontin in 1996, the misinformation re- garding its half-life, the misnomer of calling “pain the fifth vital sign,” etc. What can be done to stop it? This is a very challenging task. In 2017, there were around 75,000 deaths linked to the inappropriate use of opiates in our coun- try. The United States consumes 80% of the global production of opiates in the world. The other 20% is used to manage the pain of the rest of the word. This is alarming if we consider that the U.S. comprises only 4% of the world’s inhabitants. Thankfully, the curve is starting to decline thanks to the effort of increased awareness in the population, better information inmedical schools about the ap- propriate use of these very dangerous anal- gesics and the new regulations and guidelines that are being enforced by the CDC, the FDA and the different state medical boards in the country. Globally, the World Health Orga- nization is of great help. The fact that these are controlled substances allows the DEA to be very helpful in enforcing the controlled substances laws throughout the country. An- other example would be to limit the opiate prescriptions by surgeons for postoperative pain control to one week as contrasted to the very liberal amounts for a whole month currently allowed. As well as making patients aware that dosages of 800mg of Ibuprofen and 1300mg of Acetaminophen every eight hours are enough to modulate most of the different kinds of pain (with the exception of cancer pain and patients on palliative care). Additionally, understanding that pain is not only triggered by an organic cause but also that there are emotional and psychological factors involved in the response to pain by the human being helps. Because of the addictiveness of many pain killers, pain seems to be one of