However, for some patients opioids might
still be the best solution. Nonetheless, a bigger
picture must be established before prescribing, notes McAnally.
“When we’re talking about drugs with
high-abuse liability like opioids, we, as physicians, have to be thinking beyond just this
individual patient. We’ve got to be thinking
from a public health standpoint. And there’s
a huge problem with diversion of these
drugs,” he says.
Whether further restrictions on opioids are
handled through federal or state legislation,
the original source of their popularity—pain—
isn’t going away. So neither are pain management clinics, though the way pain is managed
continues to evolve.
Looking ahead, Wollrich says there is potential in the development of regenerative
therapies, such as platelet rich plasma and
stem cell treatments.
“Unfortunately, they are relatively expensive
and are not typically covered by insurance companies,” Wollrich says. Still, he says the move
toward regenerative and alternative therapies in
Alaska is quite strong.
“As regenerative therapies further develop,
they will likely be a huge part of treating pain
in the near future.” R
Isaac Stone Simonelli is a freelance
journalist and former managing editor for
the Phuket Gazette.
minimal effect on the majority of patients treated at AA Spine & Pain Clinic, Wollrich says.
“We prefer to offer non-opioid treatments
where they will be effective for our patients.
Certain patients who have extreme condi-
tions, such as multiple failed back surgeries or
massive traumatic injuries, may be offered a
neuro stimulator or pain pump as a treatment
option,” he says. “We work with each patient
to achieve a manageable pain plan.”
As AA Spine & Pain Clinic doesn’t make
any money from prescribing medications, the
changes have had no impact on their bottom
line, Wollrich says.
McAnally says the changes have also had
a minimal impact on his business. In fact, if
anything, there has been a slight uptick in
referrals from general practitioners who are
becoming increasingly wary of prescribing
Patients, and the Public
“I’m very restrictive on how I prescribe opioids,
and I was doing this before. It’s not that I’m
reading the weather vane and changing my
practice,” McAnally says. “I actually left the
OR and went into full-time pain management
because I perceived, had been perceiving for
several years, that we’re having a problem here
with how we’re managing pain. And that we’re
getting people hooked on opioids. And their
pain isn’t getting any better.”
McAnally points toward the National
Institute of Health’s National Pain Strategy,
which was commissioned by the US Depart-
ment of Health and Human Services.
“It’s still in a research and development
stage. Implementation hasn’t started at a na-
tional level. But, some of the key points of this
national pain strategy—what we’re being told
we need to do—involves a ton of education,”
he says. “We’re being charged with educating
not only patients but also providers because
a lot of frontline clinicians in primary care
have absolutely no idea. There is a reason that
we have pain specialists—it’s so complicated.
Just like cardiology or neurosurgery isn’t in
the purview of primary care. Chronic pain
isn’t really either.”
Part of that education for clinicians and
the public is taking a holistic approach to
treating pain through the biopsychosocial
model, which attributes medical issues to the
intricate, variable interaction of biological
factors, psychological factors, and social fac-
tors, McAnally explains.
“For example, there is excellent evidence
out there that stress leads to coronary diseases
and can even cause cancer. There are so many
examples of this,” McAnally says.
“What I’ve learned in fifteen-plus years of
doing this is that if I do not address someone’s
psychosocial components, their emotions,
everything, there is no way I’m going to be
able to help their physical complaint.”
Another component of the National Pain
Strategy is focusing on preventative medicine:
a refocus on changing lifestyles to prevent pain
from happening rather than trying to react to
it. This comes down to helping patients create
healthy eating, sleeping, and exercise habits.
RIGHT HERE AT HOME
At the heart of Fairbanks is a community where everyone
plays an integral role. At FMH, we provide our neighbors
with the personalized care they deserve, and all the services
they need. That means you get the same skill and surgical
technology as the Lower 48, but right here at home from the
doctors and nurses who specialize in Fairbanks.