Changing the practice of prescribing for pain: One physician at a time
Q&A with Shannon Jantz, MD, Colorado Permanente Medical Group
Throughout 2018, Colorado Medicine has featured several stories about organizations and health systems in our state making important changes to address the opioid crisis in our country. This month, we want to focus on efforts at the individual physician level. What can you do today or tomorrow to impact change? Here we talk with one physician about what she is doing in her practice to change the way she addresses her patients’ pain.
Shannon Jantz, MD, is a family medicine physician with Colorado Permanente Medical Group (CPMG). CPMG is one of the state’s largest multispecialty medical groups and serves the 660,000 members of Kaiser Permanente Colorado. Jantz also serves as a committee member on the CPMG Governance Council here at the Colorado Medical Society and sits on the board of the Colorado Academy of Family Physicians.
What’s the first step in talking to patients about pain?
As a primary care physician, I deal with both acute and chronic pain every day. One of the most common acute pain conditions that I see is for back pain, whether from an injury, overuse, strain or long-term pain for which they are finally coming in to be seen. One of the first steps after empathy, of course, is to actively educate my patients about pain and the role of medications versus adjuvant therapy in treating pain. Medications have a relatively small role in the overall management of pain and I believe helping patients understand that is very important.
How do you address opioids?
When prescribing for more acute pain conditions I set the patient’s expectations up front that opioids are really only intended for the first three to five days. And at the same time, during those first three to five days, we need to use scheduled acetaminophen and ibuprofen (when patients are able to take those). Recently, while splinting a patient’s fractured wrist, I explained to the patient about new data showing combination of acetaminophen and ibuprofen is just as efficacious for acute pain control as a dose of opioids. The patient was surprised – and very receptive to trying this instead of automatically going for opioids alone.
What about chronic pain patients?
For my chronic pain patients, I have worked very hard to make sure they are on multiple non-opioid pain medications and at appropriate doses. As physicians, we know this takes time and education as many patients are hesitant to take multiple medications. However, pain is complex and we need to treat it from a variety of angles to create a safe and successful plan.
Are other physicians you work with on board with this approach?
Working at Kaiser Permanente I am fortunate to have excellent specialty colleagues who provide the same messaging about the importance of both non-medication treatments and non-opioid pain medications in the treatment of pain. The more we all can work together to provide similar messaging to our patients the better our long-term outcomes will be.
We’re interested in how other physicians in the community are changing their practice of prescribing for pain. Contact us at firstname.lastname@example.org to share your story.
Posted in: Colorado Medicine | Initiatives | Prescription Drug Abuse