Finding Alternative Ways to Treat Pain, Stem Opioid Epidemic

Urgent need to cut rates of opioid addiction and drug deaths leads hospitals to new pain medications and one doctor to an unusual approach

Sagar Parikh is an Interventional Pain Medicine Physician at JFK Johnson Rehabilitation Institute in Edison.
Efforts to combat New Jersey’s epidemic of opiate addiction have prompted new investments in treatment centers, counseling programs and alternative medicines for those already hooked. But drug use still killed nearly 800 state residents in 2014 and their numbers continue to rise.

An annual study by America’s Health Rankings found that the rate of drug deaths in the Garden State nearly doubled between 2012 and 2015, rising from 6.8 deaths per 100,000 people to 13.1 per 100,000 last year; 27 states reported higher drug death rates in 2015.

In addition to expanding treatment options, there is a growing interest in reducing the number of highly addictive opioids that enter public circulation to start. While painkillers like codeine and oxycodone have brought relief to millions of patients, many users have become addicted and the pills are frequently diverted into the black market.

Dr. Sagar Parikh, an interventional pain expert at the JFK Johnson Rehabilitation Institute in Edison, is part of a new wave of doctors who are also looking to stem the flow of opioids. By trying to identify the source of pain and reduce its root cause, he hopes to cut down on the number of painkillers prescribed to his patients.

With training in both physical rehabilitation and interventional pain management, Parikh treats patients with arthritis, diabetic nerve pain, serious backaches, and other painful conditions and injuries using a mix of nerve blockers, physical therapy or alternative treatments, like acupuncture.

“Opioids are not the only answer,” Parikh said. “When used properly, they can be very effective. But we have to be able to use all these strategies to control what we prescribe.”

For more than 20 years, doctors have made a conscious effort to include a patient’s comfort level in their clinical assessment and treat their pain along with other symptoms of any medical condition. Opiates quickly became a popular solution and, nationwide, doctors wrote nearly 200 million prescriptions annually for the drugs in recent years.

[related]But the drugs – which also slow respiration and heart rate and can cause liver damage – have led tens of millions of Americans to become addicted. In New Jersey, tens of thousands seek addiction treatment each year. The federal Centers for Disease Control and Prevention released the first guidelines for opiate prescriptions this past spring.

To help reduce the availability of opioids, public officials have created electronic databases that allow physicians to see if patients are abusing medication by obtaining drugs elsewhere through “doctor shopping,” or other techniques. New Jersey’s
Prescription Monitoring Program, created in 2011, has some 59 million entries and is linked to systems in New York and other states, but critics contend it is not strong enough.

Several New Jersey hospitals are testing efforts that encourage the use of less-addictive pain medications for emergency room patients. This includes a pilot program at St. Joseph’s Regional Medical Center in Paterson, thought to be the first of its kind nationwide, that urges doctors to use nerve-blocking drugs or shots, or painkillers like ibuprofen, before turning to opiates.

Parikh, at JFK, said his practice is still somewhat unusual. “I think what I’m doing is still somewhat of a novelty,” he said. “This multimodal approach to pain is not something most (doctors) look at.”

Sometimes a prescription is appropriate, but the goal is to use these pills sparingly, if at all, Parikh said. The key is getting to know the patient and diagnosing the true source of their pain. Patients must be on board with the treatment and sign a “pain contract” that outlines their responsibilities and requires them to have regular urine tests.

“I think of myself as the coach and my patients as the athlete,” he added. “There’s always a role for pain medication,” Parikh added. “But we’re beginning to realize that for any pain medication, it’s only going to cover you for a short amount of time. It’s not going to get you healthy.”

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