Chronic Pain Management Program

Medications

Buprenorphine

Buprenorphine is the mainstay medication of our pain treatment program. It was created specifically as a chronic pain medication by a European pharmaceutical company in the 1960s. It has been in continuous use since that time. Buprenorphine has proven far superior to short-acting opiates for this purpose because it has a remarkable combination of beneficial characteristics possessed by no other pain reliever. Tens of thousands of patients in Europe have had chronic pain well controlled for up to 50 years without significant adverse effects from long-term use. This strong medication has not seen wide use in the USA for pain control because it was not heavily marketed to physicians like short acting opiates were. This heavy marketing was one of the causes of our current opiate addiction epidemic, and is the basis for thousands of lawsuits against pharmaceutical companies. This strong medication is a powerful and a long-lasting pain reliever. Narcotic pain relievers are compared to morphine using the Morphine Milligram Equivalent Scale. The pain relief produced by 1 mg of this medication is equivalent to the pain relief from 60 to 100 mg of morphine. Because it is a partial stimulator of the opiate receptors instead of fully stimulating, as other opiate pain relievers do, opiate tolerance stabilizes at a constant level. Because of this, patients who take it on a daily basis will continue to get the same amount of pain relief without the need to periodically increase the dose to get the same relief as we see in patients on short acting, full-stimulating opiates. This strong medication is a controlled substance. It can be harmful if taken by someone who has not build up tolerance through opiate use. It can be extremely harmful, or even fatal if taken by a child. It is important that your medication be kept in a lock box or safe so it will not be stolen or taken by anyone except the patient for whom it is prescribed. To decrease the risk of misuse and diversion, Pennsylvania State law requires that this medication be prescribed electronically. Telephone and written prescriptions are no longer permissible.

We do not prescribe any other controlled substances.

Medical Marijuana

Dr. Simpson is certified with the state of Pennsylvania for the medical marijuana program. Medical marijuana has been demonstrated effective in treating a wide variety of pain conditions. Unfortunately, research on marijuana for medical purposes has lagged behind other medications because the federal government has designated it a class 1 narcotic, thus prohibiting most research. This has started to change as the majority of US states have now established medical marijuana programs.

Dr. Simpson can certify you as a medical marijuana patient if it is agreed that this would be medically beneficial.

NSAIDs

(Ibuprofen, meloxicam, naproxen, aspirin, etc.) and Acetaminophen (Tylenol)

These prescription and over-the-counter medications are effective for pain relief. They have safety issues which require they be used with care. Most patients with severe pain have found they do not work for them because of the severity of their pain. However, after the severity of pain has been significantly reduced with Buprenorphine, these medications usually work to reduce or eliminate periodic breakthrough pain. Your pain management specialist will discuss these medications and give appropriate recommendations and safety advice.

Gabapentin

This medication may work for neuropathic (nerve damage) pain which often does not respond to other treatment methods. Taking gabapentin with Buprenorphine carries some risk because both medications have a mild effect of suppressing respiratory drive, and the combination has been implicated in a higher risk of death when overdoses occur. If safer medications have not effectively controlled neuropathic pain, you may wish to discuss with your pain specialist careful addition of this medication. Because of the increased risk, it is vitally important that this medication be taken only as directed and that it be started only after other methods to control neuropathic pain have been tried unsuccessfully.

Antidepressant/anti-anxiety medications

Some medications developed and approved to treat depression and anxiety may reduce some forms of chronic pain. Your provider may discuss these medications with you to see if they might help. Benzodiazepines are not used by PRMC providers for pain control, and we do not prescribe them.

This medication was developed to control seizures, but helps with some forms of chronic pain. It must be carefully used because it produces grogginess and drowsiness in some patients

Other medications

There may be other medications you have found helpful for your pain. Please discuss these with your provider so you will both fully understand all aspects of your individualized comprehensive pain management program.

Counseling

Counseling and education are important aspects of your treatment. All PRMC sessions include counseling. Additional specialized counseling may be recommended if your pain management program provider feels it would be helpful.

Urine Testing

One of the challenges of treating pain with mainstay treatment medication is achieving effective levels of medication in the body. This is monitored by measuring mainstay treatment medication levels in the urine to ensure enough medication is entering the bloodstream for good pain control. Urine is also tested for other drugs in the system. Random urine testing is done on all PRMC patients. Intermittently, urine sample collection will be supervised to discourage sample falsification.

Urine drug screening is included as part of your monthly program fee. If your urine sample is sent to the reference laboratory to be analyzed for drug levels, you will be billed directly by the laboratory.

Acupuncture

Acupuncture is usually helpful for chronic pain. Your PRMC pain specialist may refer you to an acupuncturist for specialized treatment focused on additional pain relief.

Physical Therapy

Chronic pain may be caused by and may cause changes in the way your musculoskeletal system functions. Physical therapy can often reduce pain, improve function and improve quality of life. Your PRMC provider may offer a physical therapy referral as part of your treatment.

TENS

Transcutaneous electrical nerve stimulation (TENS) Is a safe and painless treatment which may be used at home. It involves mild electrical stimulation of nerves from electrodes placed on the skin. This can block pain impulses from the affected body part to the brain where pain is perceived. Your treatment provider can help you obtain and properly use a TENS unit for improved pain relief.

Chiropractic Treatment

Chiropractic manipulation can reduce musculoskeletal pain and improve functional ability. If advisable, we will recommend and work with your chiropractor to optimize pain relief.

Mind-body Therapies

Mind-body therapies use the mind’s ability to change functions and feelings controlled by the body’s automatic processes when these processes are causing problems such as pain. These therapies can include meditation, mindfulness techniques, relaxation training, biofeedback,Therapeutic touch, reiki and others.

Several types of psychology-based therapies such as CBT (cognitive behavioral therapy), hypnotism, and supportive talk therapy have been proven effective in reducing and managing chronic pain

Physiatry

A physiatrist is medical specialist trained in evaluating problems with the musculoskeletal system to identify and treat malfunctions in the way parts of the system (bones, joints, ligaments, tendons, muscles) work together to provide movement and postural support of the body. These malfunctions are a common cause of pain. When the physiatrist identifies system malfunction, a treatment plan is formulated to correct the problems and return musculoskeletal function to a state of harmony. The treatment plan usually includes multiple methods of treatment, many of which are listed elsewhere on this page. Your treatment provider can arrange consultation with a physiatrist if needed.

Dietary Therapies

Diet plays a significant role in some pain conditions. For example, some foods trigger migraine headaches in people subject to them. Your provider will discuss dietary changes If they may help.

Trigger Point Injections

Trigger point injections are effective at relieving highly localized pain caused by muscle function abnormalities. This treatment has also been effective with fibromyalgia and chronic headaches. Your provider may refer you to someone who specializes in trigger point injections.

Surgery

Surgery is sometimes the best treatment for a painful condition, and may offer the chance for a cure. Your pain management specialist at PRMC will help you decide if consultation with a surgeon is warranted. We can also help you obtain more effective management of pain during the operation and postoperative period. We will be happy to work directly with your surgeon and your anesthesiologist to achieve the best pain control result.

The fee for the PRMC Chronic Pain Management Program is $275 / 4 weeks. We do not accept insurance company payments. We can provide you a receipt with the necessary codes to submit to your insurance company for reimbursement.