In Midst of Opioid Crisis, Pain Management Clinic Takes an Evidence-Based Approach

UIHC's Pain Management Clinic takes an evidence-based approach to treating chronic pain

See Dr. Rastogi's interview with KCRG here.

In the latest piece of grim news about the opioid crisis in the U.S., the National Safety Council recently reported that Americans’ odds of dying from an opioid overdose are now higher than their odds of dying in a car accident.

Iowa hasn’t experienced the opioid crisis as deeply as many other states. Yet, nearly 300 Iowa deaths were attributed to opioid overdoses in 2016, and 2.1 million prescriptions for opioids – 68 prescriptions for every 100 people – were filled in Iowa in 2015, according to the National Institute on Drug Abuse.

But very few of those prescriptions came from the Pain Management Clinic at University of Iowa Hospitals & Clinics.

“We serve mostly chronic pain patients, and opioids are not appropriate in those cases,” said the clinic’s medical director, Rahul Rastogi, MD.

“There’s no good clinical evidence to support the use of opioids in treating chronic pain. In fact, there’s not even weak clinical evidence supporting their use in chronic pain,” Dr. Rastogi said. “It’s not that we absolutely refuse to prescribe opioids, but we make evidence-based decisions to employ options for our chronic pain patients without exposing them to adverse outcomes from long-term use of those options. Opioids are not a fit in our aim to ‘first do no harm’ and aren’t helpful for most of the cases we see.”

Opioids are most effective in reducing acute pain, such as that experienced immediately after a car accident or surgery. But even limited use of opioids can “prime” the brain toward dependence, a first step in the direction of addiction, Dr. Rastogi said.

Worse, opioids have been associated with changes in nerve endings, so prolonged use can actually make a patient’s pain worse.

“Over the years, we have realized that medications are not always the best option” for treating lingering pain, Dr. Rastogi said. “A multi-disciplinary approach works better – physical therapy, psychology, nerve modulation techniques, and short-term use of analgesics.”

The aim for clinic providers is “restoring functionality for the patient,” he said. “Pain is utilized as a marker of functional loss. If you can’t sit at a desk or get down on the floor and play with your grandchildren, our goal is to make those things possible for you again.”

The Pain Management Clinic has five clinical faculty, two clinical psychologists, and a pharmacist on staff to help manage patients’ pain appropriately. Services are provided at UIHC and at Iowa River Landing in Coralville, which recently expanded to five days a week and added evening hours on Wednesdays and Thursdays.

Thursday, January 17, 2019