Why You Don’t Need Opioids to Treat Acute and Chronic Pain
By Dr. Yuen Cheng
As a pain management doctor, I treat the whole spectrum of acute pain and chronic pain.
My specialty is interventional pain management, which utilizes a multidisciplinary approach to managing your pain. This multidisciplinary specialty is what makes me a perfect fit for Advanced Pain Care — a practice dedicated to multidisciplinary collaboration in treating pain patients.
At APC, I collaborate with the practitioners in neurosurgery, orthopedic surgery, rheumatology, and addiction medicine to provide a tailored pain management plan for each patient.
Who Can Benefit From APC?
I’m a detailed-oriented, non-judgmental person who builds a strong rapport with each patient. I build that rapport by listening and observing carefully. So when I see a pain patient, I can usually tell if you’re stable and can manage your medications without trouble.
But, there are a lot of chronic pain patients who are struggling with opioid dependency. And dependency exists on a spectrum.
You might be someone who is experiencing chronic pain and taking a pain pill two or three times a day. If you can go about your normal, daily life — working or taking care of grandkids or things like that — your pain is likely well managed.
On the other end of the spectrum are patients who are addicted to their medications and would benefit from APC’s addiction specialists.
Most patients fall somewhere in between those extremes, which is why it’s important to me that I be a good listener and pay attention to how patients behave. I spend a lot of time with my patients, seeing them monthly or every few months.
I get to know you as a patient and a person, which makes it easier to pick up on whether you’re running into issues.
Being a good listener helps me find out what’s going on in your life.
It’s important to me that I not be judgmental, so you feel open to talk to me about your issues. The more honest you can be about your struggles, the easier it is for me to direct your pain management plan the right way.
That might mean more interventional pain solutions so you’re not turning to medications. Or, you might need to see an addiction specialist or behavioral health professional.
It’s not about catching you doing something wrong, it’s about harm reduction. I want to reduce your emergency room visits or primary care doctor visits if I can.
Related: APC’s Pain Treatment Options
How Do I Become an APC Patient?
Most of my patients are referred to APC by another doctor, typically a primary care doctor or a surgeon.
A surgeon might send you here for post-op pain management for a few weeks or a few months.
Or, you could be someone who has never had any pain management needs before. But suddenly, you’ve got a herniated disc or some other injury that requires an injection.
Or, you could be someone who has struggled with long-standing chronic pain that has been managed by just a primary care doctor and some pain meds. Maybe things aren’t going well and you get referred to us.
No matter what brings you to APC — whether you’re an acute-pain or chronic-pain patient — you can expect a comprehensive, multimodal approach to your pain management plan.
I like to describe the collaboration among APC’s neurosurgery, orthopedic surgery, and rheumatology departments as a two-way street.
So the surgery, neurosurgery, and orthopedic surgery practitioners will send you to me for pain management if they determine you’re not a good surgical candidate. Or perhaps you haven’t tried all the other treatments available that we offer as pain doctors.
APC’s surgeons are pretty good about exhausting more conservative pain treatments before sending you into surgery. Once we’ve tried all the viable options, we’ll then decide if surgical correction is appropriate.
The rheumatologists typically send me patients with autoimmune diseases and connective tissue and joint issues for pain management. And in return, I send my patients to the rheumatologists if I think you might have an autoimmune or connective tissue disease, just to be sure I’m not missing anything.
What’s Your Diagnosis Process Like?
On your first visit, you’ll see a pain physician.
We’re the ones that take a detailed history and physical exam, and come up with a working diagnosis. We might order x-rays, MRIs, or EMGs to help make our diagnosis.
It’s pretty common that our patients have already had some imaging done or another workup from their primary care doctor or a previous surgeon.
So we look at some hard data, and we talk to you. We use all that input to come up with a treatment plan right away during your first visit.
If you’re a patient who has longstanding chronic pain, and you’re on a stable medication regimen, then you’re usually considered a stable patient who can be seen by our nurse practitioners and physician assistants. They’re very connected with the physicians and can act as our extension, which allows us to see more patients.
Can I Keep My Existing Plan or Try Something New?
The answer to both is yes. We see patients on the whole spectrum of satisfaction with existing pain plans.
If you’re very satisfied with your current regimen, then we can continue facilitating that plan (as long as you’re on a safe medication regimen in terms of dosage and the CDC prescribing guidelines).
If you’re coming from a different pain practice that prescribed the same regimen, and you don’t feel you’re getting adequate pain control, we can come up with a new plan for you.
We’ll work with you to figure out how to achieve your pain management goals.
We have really well-trained nurse practitioners and physician assistants who can adjust your pain plan as needed. They maintain an open line of communication with the doctors, so if something isn’t working they can rely on our fresh pair of eyes and ears to advise on the plan or counsel the patients if needed.
I’ve Never Been to a Pain Clinic, What Should I Expect?
I’ve noticed many of my patients who have never been to a pain management practice before having some awareness — and concerns — about the opioid crisis.
You might not have experience taking pain meds before, and you might be (understandably) reluctant to take them. We always consider non-opioid interventions. In fact, we can usually offer you something that is opioid-free to address pain.
But medication is a small piece of the pain management process. We feel it’s important to educate you thoroughly about all your options.
This is where our multimodal approach is really beneficial.
I find many patients are simply unaware of how many treatment options are out there. Many of those options have been around for decades and have improved over the years.
Options like epidural steroid injections, nerve blocks, and nerve ablations can be pretty new to patients, even though it’s something that we’ve done in the medical community for a long time.
If you’re had some experience with injections in the past, and it hasn’t been effective, we can offer more advanced techniques.
A vast majority of the pain patients we see are experiencing spine-related pain, anywhere from the neck down to the tailbone. If you’re one of those patients, and injections aren’t working for you, then we might consider spinal cord stimulation.
A spinal cord stimulator is used to treat pain along the spine, but there’s also a subtype of spinal cord stimulation called DRG (dorsal root ganglion), which can treat more peripheral pain in addition to spinal pain.
That’s typically for treating pain in the extremities, like the legs, that’s caused by a nerve injury or some sort of neuropathy.
Vertiflex is a newer device that we can implant into the spine to decompress the spine. Both the spinal cord stimulator and vertiflex are minimally invasive surgical procedures.
If you have SI joint-related pain, we offer a minimally invasive way of performing a SI joint fusion too.
Those are just four examples of the newer procedures that patients may not know much about.
But we at APC make sure we’re staying abreast of best practices and technologies too. That’s why I’m thankful APC offers continuing medical education — the time and resources to attend conferences and stay connected to colleagues.
It’s important to us to stay connected with the broader medical community to hear about the success stories and advancements from across the country. It ensures we’re providing the very best care for our patients.