Experts: There are multiple paths for managing pain

Dr. Shiyi Abla-Yao, MD, medical director of Pain Medicine of Evangelical, in Lewisburg, explains a pain treatment plan to a patient.

A degree of pain interrupts everyone's daily life at one time or another. How one treats that pain can vary depending on the severity and frequency. 

Shiyi Abla-Yao, MD, medical director of Pain Medicine of Evangelical, in Lewisburg, and Eva Gerhart, chronic pain management pharmacist with Geisinger Lewistown Hospital, agree that pain can’t always be completely stopped, but different modalities can help patients manage it.

The first step for both care providers is talking to their patients.

“Most important is determining what kind of pain you have,” Yao said. “There is nothing set in stone. Two patients going through the same event, even though their MRIs may be similar, they’re all different. Everybody will be treated as an individual.”

“I’ll spend an hour with new patients,” Gerhart said. “We spend a lot of time with personal attention to make sure we’re tailoring the medications they need to what’s going on with them.”

The first-line treatment of mild to moderate pain is acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAIDs like Advil, Motrin and Aleve).

“All can provide pain relief, but a lot of times we have to look at the background of the patient to see which one will be best,” Gerhart said.

Age and liver function might steer a doctor away from suggesting acetaminophen, while NSAIDs might not work well with a history of kidney or cardiac issues. Beyond that, acetaminophen and NSAIDs are similar in strength but differ in frequency of dosage, from four to six hours to every 12 hours.

“That’s where I would make a decision one way or the other, which makes it easier for the patient to be compliant,” Gerhart said.

Recent studies have shown that after a surgical intervention, taking both acetaminophen and NSAIDs together can equal a dose of Vicodin, Gerhart said. But again, it all depends on the patient’s situation.

“Everything is very individualized depending on what’s going on with that patient that day,” Gerhart said. “What’s most important when looking at pain is not grouping people together and saying all chronic pain is equal. There are so many different modalities that occur that we need to take a peek at and make sure we’re treating them correctly.”

“Consistency (with a physician and with following medication dosage) is the key,” Yao said. “But also understand that the patient’s body changes over time, and so do these other medications. That’s why it’s important to see their physician to see what is the best way to treat the patient.”

Whether with pain medications, injections, physical therapy or acupuncture, patients won’t always be pain-free, like TV commercials lead them to believe.

“I think a commercial is to grab your attention and say, ‘Oh my God, I’ll be good again. I’m going to leave my suffering behind,’” Yao said.

Reality is different and requires the patient to put forth some effort.

“A chronic condition takes years or even decades to develop, and so do not expect anything I do is going to be a snap of a finger,” Yao said. “People always want a dramatic change right away. It’s not just drugs. Not just injections. Not just acupuncture. We have to modify our activities. How we bend. How we lift. How we do household chores.”

Patients today are leery of opioids, but both Yao and Gerhart said there is a place for them.

“Post-surgical intervention, could short-term use of opioids be appropriate? Absolutely,” Gerhart said.

For long-term pain, other options might be better. Gerhart mentioned neuropathic agents, sometimes combined with SNRIs (serotonin-norepinephrine reuptake inhibitors).

“We’re not against using opioids,” she said. “We just want to use them only in appropriate situations.”

That’s where the new-patient evaluations can help.

“Being able to come in and see us and be heard is, I think, exceptionally important,” Gerhart said. “Not treating someone with opioids doesn’t mean I don’t believe they’re having pain. I just may know that other medications may benefit them greater.”

Another important factor is a patient’s ability and desire to cooperate with their care giver’s orders.

“We can’t ignore that there’s a person there, and we need to look at that person and see how we can best help them,” Gerhart said. “Even the best pill in the world may not be the only answer. It often has to be a full involvement of lifestyle changes to get better.”

Yao noted how seeing people in pain bothers her and spurs her on to find ways to make a difference in their life.

“But ultimately the change doesn’t come from me,” she said. “It comes from them and what they are willing to do to make a change.”

n Cindy O. Herman lives in Snyder County. Send e-mail comments to her at CindyOHerman@gmail.com.

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