Page 25 - Delaware Medical Journal - May 2017
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CASE REPORT
To address the above issues, our pain management practice embraced substance abuse counseling as an early intervention
to the patients exhibiting SUD/OUD behaviors. The program was initiated in 2012 as a physician-initiated collaboration between Dr. Ganesh Balu’s pain management practice and Kent and Sussex Counseling (KSCS) — an organization
that provides mental health and substance abuse prevention and treatment in Kent
and Sussex counties of Delaware. This physician initiated, innovative outpatient pain and addiction program is one of the an onsite substance abuse counselor to
work in tandem with the pain management physician in an integrative interdisciplinary medical practice. This collaboration helps to make real-time decisions for patients with a dual diagnosis of chronic pain in addition to OUD/SUD.
At our fully integrated comprehensive
pain management and therapy practice,
the goal was to refer SUD/OUD patients
to the substance abuse counselor. Patients found to have SUD/OUD were initiated on multimodal treatment strategies necessary for a successful treatment outcome, while addressing other factors that may be contributing to their maladaptive behaviors, including addiction, poorly diagnosed or inadequately treated chronic pain condition, or comorbid mental health disorders, such as depression.
METHODS
The diagnosis of a Substance Use Disorder (SUD), including Opiate Use Disorder (OUD), and other comorbid mental health conditions were made by a Licensed Mental
Health Counselor with long-standing professional experience in substance abuse counseling. Assessments were done in conjunction with the pain management physician who was always present during these evaluations. Once diagnosed, patients with SUD/OUD were provided counseling to focus on therapeutic interventions designed to address these comorbid conditions and monitor the patient’s progress on a weekly basis. The pain physician provided quick guidance to the counselor in understanding and addressing the patient’s chronic pain condition. Conversely, the counselor was available to provide advice to the medical team from the behavioral health perspective.
The counselor built a strong therapeutic relationship with the patient, beginning with an assessment of the severity of OUD/ SUD, impact of comorbid conditions and mental health status, including the risk of harm to self or others, and readiness to change. Counseling was implemented from a harm reduction model perspective with some patients striving for total abstinence from illicit drug usage with others striving
for a reduction of illicit drug use. Such
available on-site urine drug screening. Therapeutic strategies were individualized and evidence-based. These included motivational interviewing, cognitive behavioral therapy (CBT) interventions, teaching coping skills such as meditation, breathing, progressive relaxation exercises, and guided imagery as an alternative to narcotic dependence for self-managing stress associated with chronic pain and the path of addiction recovery. In addition, the counselor coordinated with the medical team to assist patients with access to the full array of services offered by the clinic.
Pain management medical decisions involved options to change the class of medications entirely or adjust opiate pain medication dosages and their frequency, pharmacological genetic testing to
identify metabolic variations of various opiate medications, in addition to using discontinuing the opiate pain medications entirely for continued noncompliance. In the last instance, patient’s pain medications
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