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Adventist Health 090918

Sep 5, 2018|

AN INTERVIEW WITH DR. RUSTY KINDER, PAIN SPECIALIST WITH ADVENTIST HEALTH ABOUT OPIOID USE, ALTERNATIVES TO PAIN MANAGEMENT, AND HOW ADVENTIST HEALTH HAS BEEN SUCCESSFUL AT REDUCING OPIOID USE.

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Automatically Generated Transcript (may not be 100% accurate)

This is metro schools and Entercom radio Portland public affairs program I'm Yuri blocks of OP toys are definitely in the news a lot right now and I'm mad just go this time we're going to be talking to a pain specialists to find out exactly what's going on. Unless Cisco today would like to welcome doctor rusty can there doctor gender is a fellowship training in dimensional pain specialist at Adventist health the doctor can network. And do well thank you very big plus find out first what you do what is of what is. Fellowship trained international Payne therapist. Specialist. I'm on my job is to see patients who have been living with chronic pain and try to develop strategies to help them live. Better lives sounds happier with us thing. What kind of chronic pain we talk about like he needs and Chris and any kind of chronic pain from any number of blood diseases from neurological disorders from. Autoimmune disorders down. Disparate regions in their back. Any number of conditions. How many people suffer from chronic pain that's a awful. And it's much more common than you might think it's a number one no reason for a patient to visit in a position is for chronic pain. And hello Alice Payne treated. It's sad and it's that's a very complicated and gay clergy can answered well I can definitely let me go on sentences are. Sound and so you can chronic pains treated in lots of different ways so he first yet to identify a few candor underlying source of the pain. And if you can treat that. That source. If you're treating the symptoms there's a number of different modalities down that they'll probably get into more depth a little bit later. On the bill does include medications. Psychological supports. Physical therapy. And some mourn death things that I do you like. In an injections and in surgery well. One of the things it's that we hear a lot about this in the news are open it's right rental fluids are used to treat pain. Could Greg let's talk about what what are we world believe so. Hope you reserve found an interesting. And drugs and they're they're a class of drugs that stimulate now re sectors that we have in our bodies naturally in our our central nervous system like a brain our spine. But also owners around the rest or body. They have specific effects where they help decrease the pain that those standards and a pay signals that those that are sent to the brain. There also used in medicine in some different aspects for instance it's used in concerts as a consequences. It's also used two trees son. Diseases like or some symptoms like diarrhea. So it's it's got a hold a whole host different found ways that we. Use it to treat things in. In medicine in general. Our hope goods mostly in the Intel formally say it's it lingering cough medicine and quipped I think most people are familiar with the local former teacher. And so when you talk about a acuity and there is then there's medication was of the get from the position bid abuse are also used. Illicitly on the street news so for instance heroin happens to be and opulent. And so they're they're they're used to down as a dry idea high but they're also used in medicine to help. To help with things like chronic pain in the off some become in many different forms and as an anesthesiologist. I didn't I would use that in. Surgery to help. Agency when their sleep. For instance when page Sissy thunder and seizures and Obi is a very specific effect on the body to help control vital signs like heart rate and blood pressure. And they can help prevent. Pain from becoming chronic buy on staying ahead of it now before the patient even wakes up from anesthesia. How do Oprah doing some work. So OP always work by stimulating those OP interceptors. Down in the body and invade their new live on the nervous and onions or the nerves. And today. Help decrease the pain signals that the sense trainers sent to the break. And they have dessert is there other side effects or other. Biggest people get addicted to them so they must be something else besides pain relief that people are taking them for the news cycle and psychological effects yet well there there are some one of the side effects is it euphoria. Around which can be hands and people take advantage of that. That's there's also a number of other side effects on the body we mention that there is that it affects the GI tract there's there's actually receptors in the GI tract and can cause things like constipation. Nausea and I'm vomiting. Bitter they can. Have a whole host of effects on your hormones for everybody for instance. Now ended take. Oak yours can have decreased testosterone levels and might have to have that replaced well. Why do oh boy oh pew aides have such a bad reputation. So. I think should it be Marty mentioned and heroin earlier and I think if if heroin and what your family members I think your whole family tends to have a bad reputation. That's that's part of the issue. I think part of the issue is also of the and the media coverage of these medications is pretty universally negative I'm talking about the best of the bad things that happen with these medications. That sound. There's some of the bad reputation of abuses is pretty well deserved for instance we know that in 2017 last year the National Institutes of Health. Stated that there is over 49000. Deaths associated with Opie and overdoses well by farther and the most ever and that number's been increasing. Every year since 2002 in the last few years have actually been the highest. Increases in overdose deaths from mobile it's mostly due to the knees nearest and technical Buick that are being used illicitly like to know and carpet to know. Think our offense know is that been in the news a lot lately. And medications in more than a hundred times. More potent and its and its parent drug fentanyl. While was that something that there was an overdose of and a large park somewhere in the instances recently because of that synthetic. Well good. Some I'm not sure that same case it was a very resent. String of overdose deaths from synthetic what they call synthetic marijuana I think that's good and bad term McKay two of that was laced with other and ingredients in that I believe focus might have been a part of that. Because open old buicks are in the media so much if at all almost get the sense that anybody who takes. And I'm hopefully going to for pain medications is automatically addictive that's not a race. Yet that here exact spirit has not the case it it is true that sound it seems like you'd you'd think that anybody in. If it seems like the inevitable end. And points were taking a purist his addiction. On this team to kind of watch much the media coverage of medications and it is not your vast majority of patients to. Teco viewers do not become addicted and in fact it's a fairly soon. Emotions a small now but a smaller percentage less than 10% or so of not patient it's exposed to will be goods and and developing some kind of use disorder or addiction. Why do some people get addicted. That's something that word really is trying to figure out sound there is there's a lot of different. Factors play into. Someone's risk of becoming addicted. We knows there's a genetic component for instance when we screen patients for risk. Misusing opulence. All the questions surround it family history of addiction and alcoholism. We also know that just if you take their medications for funds say if you're doing it as an experimental not to get high. If that says that's a big risk factor for leading into addiction even if you started started innocently. So if you if you have surgery her doctor prescribes you own a bottle of of open it's what happens when you're done with that do you feel differently when you stop picking. That's different in every. Situation so we know that if you take it at lower doses for short periods of time and there is relatively. Sound minimal side effects to stopping the medications. For instance a lot of the recommendations for after an acute injury after surgeries to take these medications prep the lowest dose possible for approximately three to seven days. And if you do that using able to stop it without having any kind of side effects your body hasn't changed enough adapted to the medications enough to have significant withdrawal. However if you're on high dose moderate to high doses for for long periods of time you're very likely to have challenges. Stopping the medications without going through some withdrawal. I was wondering about people with chronic pain that could take you for a lot longer defendant stopped. Bull what are the what one of their what is their life like what happened. Un. So stop being here. Pain medications if you've been on moderate to high doses for a long period of time no matter what the situation. It's important to do so and a slow controlled manner. If you do it abruptly you're gonna have severe withdrawal symptoms. Very. You know very comfortable and you cry Pena may have gets so much worse you have difficulty sleep being. You mood changes on your heart races you sway you feel really uncomfortable. And our goal is forever gonna stop medications is try to minimize those effects much as possible on and to do so you and we kinda wanna makes low. Changes to these medications over time. Is it true that higher doses of oak goods equal more pain relief. On that's. That in a true innocents as true so on. For instance after surgery. Com or after an acute injury if you take the medications. If you take a higher dose of medication you're gonna have a better affect. In terms of treating that they be also gonna have more side effects. That's a different question we talk about long term use of medications. There's really no good information out there that that tells us higher doses of these medications taking a long term. Actually helps pay more in factors there might be a trend towards higher doses of these medications being less effective for chronic pain when you take a long term. Is there a boy appointments committee gets used to taking it and they just automatically start taking more because their body is requiring more if you're really pure and addicted sort of person in a hand even if you even if you're not don't have an addictive personality you're not getting in. And on into addiction issues if you're taking this medication for legitimate reasons you may find the effects of the medication become less and less overtime we call that tolerance in the medical field. And oftentimes to over power that tolerance on patients will require higher doses of medication just to maintain the keynote. And again neck is that your question about higher doses equaling more relief. It doesn't necessarily give you more released escalating dose at that point you're just maintaining it seemed link that you had to lower doses previously. Could device getting used to the medications that probably a point was somebody that has chronic. Pain that they maybe think oh I should start reducing this and try to get off this and then their pain comes back so they go back. Who have a good high dose. This can be a vicious circle little bit yes so. For instance somebody that my town. Here's something from a family member sees something in the news and makes it feel guilty about that are there medication management and and that there on and they decide to. Through their fills out the window lower percent is gonna stop these I don't I don't like the stigma attached to them. They will have challenges and they will go through withdrawal in part of that withdrawal syndrome is increasing pain. And it's Indiana can be vicious cycle and make it may be. In reinforced that patience these medications are actually doing a lot more than what they actually were because of how terrible they felt when they stopped it. And so that strategy of just stopping right away is not a good one if you do it and it controls all manners the vast majority of the time and this is sported. I'm buying. Case reports and by animal and human studies if he's if you've. Slowly decrease medications to lower doses were completely come often do Leo he was for chronic long term on cancer pain. The likelihood is that you have similar or even better pain. Super interesting yeah well that's grace. We're talking today with a doctor rusty candor and pain specialist at Adventist health. And then for the cell have been really successful in. Decreasing a political purely news whenever Americans think we are and how how does hello how you been doing that. So on that Adventist health though we've been part of this kind of growing. Movements and in the United States over the last several years of sun kind of this addressing this but they've they've consider the OP early crisis the so called popular crisis. Com. There is and we recognize that there is then over prescribe being. On that cinders that verb recognizing addiction more in the fact that the overdose and overdoses are going up. We in fact saw that between 1992 in 2011 every single years there was an increase of prescribing year over year up until 2011 which was the peak. And that's when this whole tide started turning. And since that time we've actually decreased opulent prescribing in the United States across the board of by about 4% each year. And this mystery senior being the biggest drop. I'm so far and on and that's from efforts. And regulatory boards across the across the country and better restrictions and better guidelines. About this and about these medications. Found. Opening round in dentists candy canes and started really addressing this issue into does 152016. When the American Medical Association started their opener task worsen and or get started to task force and we started our own task force it added Venice. Groups of people getting together tranda. Use evidence based medicine and to provide this care for patients and help. I'm guide. And guide protocols for the rest of the providers so for instance and our and our pain clinic we we need at least once month and we talk about. Ways of developing protocols for. I'm intake like how what questions you ask patients when they come in how we screen for them how often should receive them and we provide guidelines. To our providers so that they have something tune to look at too. To have some some guidance on how to best manage these patient. And it just bag knowledge and intend. Helping them understand the risks of these medications and thinking about it more. Has had a dramatic. Effect on Oprah prescribing in just the last two. Twelve months we've had a 23%. Decrease down in a PO prescribed it. In the Adventist that Portland Adventist health system while 20% 20% decrease in that's a lot this out outpacing the national and stay veterans. It's great that it's kind of turning around deepened we're doctors kind of over prescribing the pastor of what was loop what was the reason. That's a complicated question that says that there's a cultural change in the 1990s. There was. There was a lot of pressure on physicians in the medical community in general to not under treat chronic pain. And OP always were one of the thought to be one of the best treatment options for chronic pain at that time. So if you are not treating a patient with chronic pain I prescribe to deal to aids you were thought to not be providing appropriate care. So as a cultural thing in part parlay the government had. Was a part of that issue as wells the drug companies. Doesn't that had lobbyists over in the were pushing for these medications so. It did took some regulatory changes to kind of separate those things out and really start looking at. Some of these beater on studies on chronic pain no Hewitt and realize in the that these are not. Necessarily the best treatment for. For chronic pain and you couple that with the fact that we have. This. This overdose crisis with Tokyo it's. Down looking at Alden risks and the fact that did the benefits. Don't seem to be is. As good as they were as we thought they were in the ninety's all that's kind of changed our culture. About how we think about these medications. Starting in the ninety's it meals that have more chronic pain well what happened why were cool I do why is it in the ninety's and that the scheme about. High end and I think it comes down to. What I mentioned about some pressure on physicians and that came from. Society's. Medical societies and also came from on the drug companies. There was a push to try to treat pain. It's a good thing that we're focusing on chronic pain I think for many many years it was even a medical specialty now until May be there in the seventies. When is starting to recognize or say this is that something that really affects people's quality of life which actually. Speaking care about this and it's not a heart disease and it's not liver disease or lung disease it's not gonna necessarily. None directly kill you bit. It's still. Fact it's it's a matter of quality of life and being able to function and be happy in those things also have secondary effects on your on your longevity. So. It's been recognized in I think the fact that we're focusing on and on pain in for a wild prisons and Gaza medical school we called it the fifth vitals. He was a fifth violence and could name. Got all your other things blood pressure harder in all that nannies and and you throw in pain and it de emphasis on that was let's think about it. People suffer and we need to do to limit suffered so that's a good thing. Now it's a different question did. Talk about how what's the best way to and to manage and our our thinking about the role of both goods in that scenario was changed quite a bit over the past twenty years. They don't feel it's just come about in the nineties are there really is a relatively new. Go relief mechanized and it's been around done before we had FDA before we had medications. Old aging cultures we use opium poppy to to alleviate suffering. Round and to read we derived the first don't feel it's from from the Oak Hill and poppy. And then since then down to created synthetic and medications have similar were. Different kinds of effects of the testing units in congress after. The street nature gave us this yeah jets comes through that comes from the poppy planet right the condenser. So what are some alternative treatments to pain in the foot for trying to not abuse OP it's as much. What are next alternatives. So. There are a whole host of alternatives and but I I try to look at them not as just a list of things that you can Triad. I try to think about it is we need to develop a comprehensive strategy. Now on to manage the pain. Com and openly sometimes have a rule for that. In that but it's we we like to think that's a minor role as opposed to the major rule for. So we're trying to use any other modalities that we can to help patients and that includes other medications. Com there's and some anti convulsive medication some anti depressant medications muscle relaxant. Armed anti inflammatory these time Tylenol it and a whole host of alternative. Herbal supplements and things that people use them for pain. I own and we also look it's. Non pharmacological non drug therapies like physical therapy. And mind mindful this and and then in my case my field we kind of folks on. And kind of day it will be calling international therapy that's the in. Injections spinal injections and nerve blocks they can help out with all the diagnosis of a chronic pain issue but also. Non health. Help manage the pain long term. I'm assuming they're probably instances where medication is maybe the only alternative. Is that correct. Medication of some sort. I've never said medication of some sort is the only who is the only option. I think there's always something else that that you can provide in addition to into in addition to medications to help with the patient. Whether that's just helping with coping skills whether that's on the increasing exercise and and diet changes. And sometimes like we mentioned. And different injections therapies and nerve blocks that are burning procedures. On surgeries. Some give and take you know people queuing for a long time for chronic pain in the you feel like they wanna stop because it's affecting their. Other life how to lead and what do you recommend for them. I recommendation if you decide that you're trying to you on change. Your strategy for managing your pain. Including changes to. Hero doing their. I and I recommending you work closely with your doctor or clinician. Perhaps if years you've been managing dating these medications managed from a primary care provider. It might be good idea to have a cost issue with the that they specialists like myself. Kind of talk about strategies that can help with that. And that way take some of the burden off trying to figured out on her own and it and it provides a safe. Form and formats and slowly decrease in medications. Too gifted to get your goal and also be able to work with different alternative therapies while your making those changes the medications. Police say the withdrawals can be pretty awful I'm assuming a salute. So they should come ducky do you see patients obsolete now. However however the house that changed in the last few years do you increasing more patience because of of pain medications. I think there there is more. There's more transition. Chronic pain patients that are taking. Di Leo you always long term away from primary care providers. To pain specialists. So there's been a big movement that are so I think our field in general is growing in receiving more. More more and managing more more patients hooked them more time in part that's it there this recognition of the open a crisis that part of its regulatory. There's a lot of fear in the medical field about. Not doing things the right way and getting in trouble losing your medical license. Com and I've seen that I see some clinics basically stopped seeing any chronic pain patients and if you call their clinic to be established as a primary care provider. And you chronic pains under under problem list bill built either on immunity except you because of that. While this that's kind of shocking actually. India it is so fortunate so we have about a minute or so tell me about what you've seen the future of pain management. So the future pain management. Is is abroad horizon we. So many different technologies on the way for instance one of the one of the main things that I use for. A pain management one of my favorite modalities to uses something called spinal Christine you later. For people who maybe had back surgery is a multiple back surgeries continued to have nerve pain. On in their extremities. I'm very calm and announced our Christine there's a technology that helps change those pain signals so the patient can live call and have quality of life. You live functions spent time with their grandkids. That that technology just that technology has grown Neeson downs over the last ten years in terms of our understanding of different algorithms for electricity to. Stop that pain. And understanding with we used functional and right can see how the body reacts to this kind of technology and has effects in the brain that are really interesting. And so that of the research in that area I think has potential to continue to keep growing and then got modality is. I think it's it's. It's gonna keep growing and skin have more and more applications as we go forward. The FDA just last week approved a new it's stimulated device for performers they can be implanted. Found on nerves like an arm in the abdomen in different parts the body other than this fine. Home where you have a wearable device that you put over it to to send the electricity to it so it's a very small implant. And all the electricity and all. Sophisticated computer technology. Is outside of the so it's it's really. That it's icy that is kind of the wave of the future in in my field at least in in terms of treating. Thank goodness for scientists and researchers at breakfast and keep going into a. Who's been great information thank you so much that you're welcome we've been talking today with doctor rusty candor fellowship trained in the menstrual pain specialist at Adventist health. Mitchell's go fees and Entercom radio Portland public affairs program. I'm Gary blocks and if you're involved with a non profit for public affairs organization or if you have an ideal for an upcoming show I'd like to hear from you. There's a microscope PDX dot com and submit your ideas you can also go to the station's website and submit your information there. Thanks for listening to metros go and enjoy the rest of your weekend.