What are the best ways to deal with chronic pain?

Tommy Tucker, WWL First News
Thursday, June 21st

Tommy talks to Dr. Harry Gould, Professor of Neurology and Director of the Pain Mastery Program at LSU Health New Orleans School of Medicine, about opioids and managing pain.


Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

Remove on OO PO aid the epidemic now and it seems as though every day there is some news about the yield Buick crisis in America. A new Colombia's study heard during the news is that. Survivors of an opening going to overdose may consider themselves lucky but they remained at heightened risk of dying. From a host of medical problems. Plumbing university says the so called in quotation marks lucky ones were also 45. Times more likely to die of HIV. Forty more times. More likely to die of chronic respiratory diseases in nearly thirty times more likely to die of viral hepatitis in the risk of suicide. Was 25 times greater and unless you think is something that's happening in the back alleys. I think GOP you're crisis primarily affects people. Come better wiped. And the other thing I would bring up is a new thing in Louisiana where by physicians are going to have to you have to go to continuing. Education classes to learn more about oh Buick prescription before they can renew their license. Doctor Harry gold joins us right now professor of neurology and director of the pain mastery program. And LSU health new loan school of medicine good morning doctor. Weren't trying thanks to take him at times. Somber. You know these are some things have become ubiquitous and everybody hears about will peel it epidemic but I think. While we know. Of it may do we quite don't know enough about it and I would ask you to go back a little bit to the history of this. And at what point did we handle a sea change in his country between. The way we dealt pain and then an ROP Lloyd's in my happened from that point. Well back in his sixties. We didn't have a whole lot of information about. Into plays and basic. Idea is achieving. It'll music's switcher and on all wee hours of meal you ordered. And general. You could use the not so be it but don't use. See the opiate medications things as they're bad medications they can get. They have addiction and and develop easily with errors and. So decorous sixties we knew that. Miles can't. And wish we'd still been bad but it in the middle eighties. There isn't yeah. Articles that came out that showed that. The risk for her opiate addiction. But significantly lower especially if you use them. Appropriately for pain. Control. The problems tended to be with people that abuse of medications. Or other medications. And they're very significantly higher risk. The other thing is that we should protesters in ideas that. England's. By the ninety's. We we're hearing that pain was something that. Could be treated should be treated you shouldn't. Worry about. The level of the dosing. The medication. Even though you're taking appropriately and became dependent on the matter and was not necessarily an addiction. Because you're doing you're treating something. Properly. The problem what she's doing that is the people. It went out everybody. In that time a bit less than 3% of medical schools taught more of them. Three hours. Analgesics. And then aesthetics. Are in payment. And so the vast majority positions are well know what they're doing their part of medications. Didn't really have any idea what the dangers where are they using it chronically. And they started to get. That. So. Into. People that saw there was a benefit for you people would come through these medications and equally as he usually auction news. Make a lot of money very quickly if you serve up something like normal intention that sort. Physician friend of mine who suggested. Opined if you will would may be part of this is because of it's vital sign that was developed in terms of pain index and I think we've all seen it with a smiley face known of the frowning face wanted to end. And also had some doctors and some facilities given doctors a bonus when it comes a patient satisfaction at the numbers are up there and what better way to keep a patient satisfied unions unlike the law nipped. If dares say they're not feeling well. Doctor Joel what would you say no that is edges anecdotal or is there any any. Evidence to prove that that might have caused dude led to the problem we have today. Let the problem opinion. We have is that there is a beginning. Waiter and understanding that opiate medications. Seemed to be less. Addictive problems and used properly. Net really. Gave way action news that are their patients. Really extra interest let predictive. And the proper settings. People that have pain should be able to have that and it. Had pain control. That was coupled with the fact that the accrediting agencies hospitals. That. Patients have a right knee pain management. More and they're war we all positions needed to be. But where. And carcass and patients. All payments are. So we were pushed to ask for that it has and should. In the sit bottle I'm came out as a result of that. In an effort to try to do. Provide the best here that we or four people. You lose it's very difficult for pain because it actually subjective. Modality it's a subjective symptoms so there's no. Sticker that you put on their foreheads as well you'd have a six level playing there at seven novel pain. People need to be able to communicate with position. Four. Are telling them what how the pain level as they need to do more. Folks didn't didn't have a lot of as much time that they should take to be in two. Work with a patient and learn from them should they don't didn't and the time change and do more than. Tell me what your problem I hit paying oh. How bad is that all the real bad dark. And then. You get medication. Because that was what was being. Produced. The faces scandal. Were important because the whole spectrum of people. Sharon pediatrics. To geriatrics. Needed to enhance some way to try to communicate and it was well as. Aren't as good as it could be. So I think that it played a role in its. From a perspective of more people were doing it. They didn't have the training or they didn't really and the time to do what they needed to actually do a proper assessment in a lot of people got medications. That shouldn't have. From well meaning positions. We're trying to do domestic code to do. So to do something on. On site doctor we had a good news in the second and any I know you've agreed to spend the hour with us and we appreciated and the questions are pouring in at 8787. And so if you wanna as a doctor something please. Cinnamon to us quickly though when it comes that and I don't mean to dwell on this that. Pain scale with a smiley face in the frowning face even if you're not looking for no appeal lawyer who would then in some way. For example Obama patient the pains really add to and I'm looking at the scale in the and the pains not that bad but it's a nuisance. Nominee go and say ten not necessarily looking for no really but it's like you know what I'm here I'm man as Omega to go away. They went and it is expectations here or not. You will learn we don't learn about pain is regarding a very well and how to describe it. And. The thing about working with the tradition when you're trying to get something. Oh. Treated. In the chance to be is honesty issue can be with them to sort that you don't get under treaty you don't get over treated. And it again and have a level to paying you look at the scale and that you have a level of pain. Don't go they hand because it's. That's the you're going into the source for information and now we're looking at something that's a little bit more experience were looking into things. In rare American in albeit for that but it it's something where word bid information and it's gonna get bad and from that result. So many text in the end and says Diane Tommy Dennis must also take he'll do a course of course. Before the end of Tony eighteen in order to renew their licenses doctor Gould is. One of the prisoners of the continuing education course I'm attending. Tomorrow's a doctor oh you would go to some of those things you would be telling dentists or physicians. As it relates to you continuing education and what they need to learn a vis a deal really its. Well the problem initially start actually people that get medications that really don't need to have them. And actually certain medications. She did. The dark actually and give analgesics and when that happens I think it. Either anti inflammatory medications aspirin. Acetaminophen or. An opiate. And if it's something that seems to be paid just stated going to be strong and problem they'll provide the opiate medication. Even though many times it's not. Appropriate medication shall which. Happening there what's what's going to be needed. So wait a minute it two. And page it is again this is. There don't eliminate the opiates from year parliamentarian. Because sometimes it's going to be necessary. But. What they need to do is initially assess the patient properly. Determine what it is that is going to PG. Primary reason that they're going to change. In them provide the medication that is appropriate for that. Problem. Not all pain pain is not just one entity. There's nerve pain there's containment associated with inflammation. There's pain mentions. In practicable that it's too strong to deal and you have to deal that. Typically more will be opiates. Something like double pane which most of the time is either that are related and it doesn't respond opiates. Four in change. In inflammatory. Process. In the confined space and cause a lot of pressure and pain in and that change and an anti inflammatory medication. Is much more appropriate than an opiate. In terms of continuing education I heard this yesterday on channel four from. Vince and a lot of MD executive director of the Louisiana state board of medical Examiner's any kind of surprised me in his when he had to say. It used to be you can give hoping your ex for a few days without any trouble. Then it's got to the point is how some of these people are addicted within two days. That's amazing to me doctor Harry gold at somebody can be addicted to something. In as little as two days but it happens. Yeah. And the part is that playing the part of what we need to access in. The. In before giving medications used to determine the risk that people have. For potential and it addiction. A lot of people can go. Take about eighteen days to become dependent on the medication. So that you have to wean it off when you're finished using it. And a lot of those people won't have any problem mentioning. Where the opiate. The problem comes in is if you enter. Some genetic predisposition. Or past history. They put you in a group where this is going to be more dangerous sure. For the patient should provide it. And wish. We should be providing. In terms of the books around that time doctor and I don't mean interrupt you but. You're the director of the pain mastery program LSU LT loans what. What are some of the the alternatives you'll be Lloyds when it comes to mastering pain. Oh we is allotted. Not a nonfarm collide to. Issue. Modalities. There's there's imagery there biofeedback. There. The error. And cold presses or impresses sharks there's a number of things that we do our look at 24 hours. I think you're paying him 24 hour deal with. With twenty fours. It's a current event if you can be able to get people to relax and get to sleep for. In six hours then you only have to deal with its. The eighteen hours. And inter wants. We. Do. A lot of people do well with physical activity. Being given that you activities for diversion lot of pain. Check a patients with pain can have a significantly lower change level. If they're working with a group to help other people with their same problem. So. It heavily utilized. Our our thinking about it trying to redirect. People. Thought or away from pain and it's I mean it is sometimes you need a little bit of penalties should be able to get them over that hump. But I think that there. Are people that do with the very best of the ones that are looking that really don't. Want to have the medications. That they need to get their life back and we called it the ringmaster is better because when people come to obtain Shatner. They think they're gonna get the pain to go away. Well that's unrealistic. And it's best if you don't have you do have some pain because detained as a viable. Mortality. Prevention and getting injured as much as you might otherwise. So we try to do is take. Dave patients and a pay and being the controller there. In which it over so they're the controller of their life. Irrespective of what. And the Bay Area. The masters thank you so I'm sorry we don't have more time and I'm hoping come back on whizzes. Creation variant form her. And you're being mayor thank you sir is a red bay get to doctor Harry Gould professor of neurology. Director of the pain mastery program LSU held new all in school of medicine.