"We’ve always tried to avoid the use of narcotics if possible, but a lot of what we deal with is acute pain. We don’t deal with much chronic pain so we don’t provide a lot of chronic pain medication. Most of what we see is acute, like after kidney stones or major surgery, where there’s a short-term need for strong pain medication. The hard thing is trying to figure out how much somebody is hurting because pain is somewhat subjective.
Personally, I’ve tried to use a lot more NSAIDs and over-the-counter pain medications but there are times where I give very short-course Percocet or Norco to cover a patient for surgery. Sometimes you have a patient call back after a week or two saying they need another prescription. It’s nothing new; we’ve always dealt with that. My office has always been pretty quick to say, ‘No, you’re beyond your postoperative period.’
If patients complain about significant pain, we say they need to be reevaluated to figure out why they have pain, because what we were taking care of has been taken care of. We’re pretty strict about that.
There’s also been an effort to recognize when patients are doctor shopping and getting drugs from multiple places. There’s a website to check if a patient has had narcotic prescriptions anywhere else in the past ‘X’ number of months. I think that’s a helpful resource.
I definitely think more about the issue now, because the milieu is different. When I started practicing we were in a different era. It was a time that if there was any pain, then we weren’t taking care of our patients’ pain enough. The big push was to get everybody down to a certain pain level. It’s swung the other way now, where we see dangers to overprescribing these medications. Maybe some pain is OK. What is manageable pain? That’s where we are now.”
Jason Burrus, MD / Birmingham, AL