The approach to pain management at Northstar Pain Care/Neurological Clinic is unique to each individual presenting for evaluation and treatment.
First and foremost, it is our position that wherever a source of pain can be eliminated, it should be eliminated. The approach to pain management therefore starts with a careful review of existing medical records followed by a detailed history and physical examination to first determine whether a treatable source of pain has been overlooked.If such a source of pain is found, further evaluation and treatment must be undertaken before a course of pain management will be pursued.
If no source of pain which can be eliminated is found, there still must be a source of pain sufficient to warrant chronic opioid management. If no such source of pain exists, we will facilitate referral to centers which specialize in management of pain without the use of narcotics.
There are, however, a significant number of conditions which will produce chronic pain for which there is no effective cure. It is our belief that individuals seeking pain relief from such conditions deserve to have maintenance opioid therapy included as part of their treatment, if they so desire. The goal of treatment is to relieve pain and improve function while minimizing adverse effects. Optimizing the use of long-acting narcotics and minimizing the use of short-acting narcotics is of paramount importance in achieving this goal. The choice and dose of narcotic need to be individualized. There are a variety of choices. There is no one-drug-fits-all approach which will allow us to optimize treatment. This approach requires an open and honest relationship if it is to succeed and the following rules need to be followed:
- Self-treatment is not allowed. If a dose of medication is inadequate, schedule an appointment to discuss this so that we can adjust the dose or change the drug.
- All narcotics must be obtained from this office. This is essential. If treatment is to be optimized, I must know what drugs you are using at all times.
- There must be no illicit drug usage.
- All patients receiving chronic long-acting narcotics are subject to random urine drug screens.
- The drugs prescribed cannot be shared with anyone.
- Our patients are responsible for their drugs and must take measures to prevent those drugs from being lost or stolen.
As an alternative to chronic opioid management, implantable devices such as dorsal column stimulators and intrathecal pain pumps can be used. While we do not perform such procedures, we do maintain close relationships with practices specializing in these procedures and can facilitate referral when appropriate.